VERSION 08-07-2013
LANGUAGE IN GREEN IS TO BE CUSTOMIZED AS PER THE STUDY PROTOCOL.
THE UNIVERSITY OF CALIFORNIA, IRVINE (UCI) CONSENT
CONSENT TO PARTICIPATE AS A HUMAN RESEARCH SUBJECT
COVER SHEET
[Title of Study]
RESEARCH TEAM AT UCI:
Lead Researcher at UCI:
Name and Title
Department
Telephone number and e-mail address
24 Hour Telephone number:
Other Researchers Finalizing Informed Consent at UCI:
Name and Title
Department
Telephone number and e-mail address
STUDY LOCATION(S): UCI
STUDY SPONSOR(S): [Name of Sponsor]
You are being asked to participate in a research study. Participation is completely voluntary. Please
read the information below and ask questions about anything that you do not understand.
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