Yale University
200 FR 11: Human Subjects Committee Verbal Consent Script Template
The following is intended as a sample. Instructions are bold, italicized and underlined. Modify
this form to fit the specific study, both in content as well as format.
Verbal/Online Informed Consent Script for Participation in a Research Study
Hi, my name is (name) and I am a (professor, graduate student, undergraduate, etc) from Yale
University (for international studies, state that Yale is in the United States). I am conducting a
research study to examine describe the purpose and goals of the study. Participation in this
study will involve description of tasks (observing you as you perform your daily tasks,
completing a survey, interview, etc.) Your involvement will require x minutes/hours. You will
receive x local currency/item for participating (as applicable).
You may experience description of risks (distress over the nature of the questions, potential for
informational risks etc.) OR (if no known risks state the following) – There are no known or
anticipated risks to you for participating. (If no benefit to participants’ state) -Although this
study will not benefit you personally, we hope that our results will add to the knowledge about
describe public good. If benefit to participants state what they are and we hope that our results
will add to the knowledge about describe public good.
All of your responses will be held in confidence /anonymous (no identifiers or code at all)—
choose only one. (If the study calls for the option of being identified this can state “You may
choose to have your responses attributed to you, otherwise your responses will be held in
confidence / anonymous.”) Only the researchers involved in this study and those responsible for
research oversight will have access to the information you provide. Your responses will be
(handwritten, audiotaped, etc.)
(If applicable use the following, if not applicable be sure to include what your plan is) Your
responses will be numbered and the code linking your number with your name will be stored in a
separate locked file cabinet. The information you provide will be destroyed (include when here
– i.e. after the study is completed, kept until publication, stored until my degree is achieved).
(If applicable – that is if the data would have any value in court proceedings, include the
following) Please note, however, that unlike information you provide to your doctor or lawyer,
the investigator can be compelled by a court to disclose this information.
Participation in this study is completely voluntary. You are free to decline to participate, to end
participation at any time for any reason, or to refuse to answer any individual question without
penalty or loss of compensation (if applicable).Your decision whether or not to participate in this
study will not affect your relationship with (NGO, university, community leaders, etc., if
applicable).
If you have any questions about this study, you may contact the investigator, (investigator name
and contact information. Include appropriate local contact name and telephone number if
conducted in collaboration with a non-Yale researcher or international location.)
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Yale University
If you would like to talk with someone other than the researchers to discuss problems or
concerns, to discuss situations in the event that a member of the research team is not available, or
to discuss your rights as a research participant, you may contact the Yale University Human
Subjects Committee, 203-785-4688, [Add country code if applicable] human.subjects@yale.edu.
Additional information is available at http://www.yale.edu/hrpp/participants/index.html
Do you have any questions at this time? Would you like to participate in the study?
NOTE TO HSC:
THIS FORM TO BE WATERMARKED WITH APPROVAL AND EXPIRATION DATES IF EXPEDITABLE
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