Consent
My name is XXXX. I am a graduate student in the XXXX Program at the University of Illinois
at Springfield. I am conducting research as part of my master’s project and want to ask for your
help. At the bottom of this consent is an electronic link to a short survey regarding XXXX. It will
take you about 5-10 minutes to complete.
I want to keep your responses anonymous. Do NOT write your name or provide any identifying
information about your XXXXX on the survey. In addition, the results of the survey will be
received electronically in a matrix format through Google docs. The researcher will not be able
to identify who sent the responses. By filling out the survey you are consenting to participate in
the research. Your participation is completely voluntary, and there are no negative consequences
if you decide not to participate. If you do complete the survey, you do not have to answer any
questions that you chose not to answer. If you do not want to complete the survey, just delete this
email.
The results of my research will be available after XXXX. If you would like a copy of the results
of my research or have any questions, please contact me at XXXXX.uis.edu or call XXX-XXXXXXX. My adviser, Dr. XXXX, can answer any questions about this research as well. He can
be contacted at 217-206-XXXX.
This research has been reviewed by the UIS Human Subjects Review Officer. Dr. James Klein
can answer questions about your rights as a volunteer participant in this project. He can be
reached at 217-206-6883.
This consent document was approved by the UIS IRB on XX/XX/XXXX and will expire on
XX/XX/XXXX.
Please keep this letter for your records. Thank you for your participation.
To take this survey, please go to this url: http://xxxxxxxxxxxxxxxxxx
(Note: the expiration date for the consent document will be given to the researcher to add to the
consent by the IRB staff.)