INFORMED CONSENT
I, _____________
, am being asked to participate in a research project entitled
“____________________________”. As a participant in this project I shall be asked to
___________________. The entire research process will take approximately __ to __ minutes.
The nature of this study has been explained to me by ________________. I understand that there are
minimal risks of my participation in this study.
The investigators have made every effort to safeguard the confidentiality of the information that I provide.
I will be asked not to put my name on the forms or questionnaires, and I was also told to not make any
identifying marks on my questionnaire. Any and all information obtained from this study that can be
identified with me will remain confidential, and will not be given to anyone without my consent.
Additionally, only the researchers directly involved with this project will be able to have access to the
data printed in the questionnaires. The consent forms and questionnaires will be kept in the locked office
of _______________for three years, after which time they will be destroyed.
If at any time I would like additional information concerning the project, I may contact ____________at
[add email address] or [add phone number]. If I have any questions about my rights as a participant I may
contact Dr. Autumn McKeel, Chair of the Institutional Review Board, at 630-947-8922 or by email at
amckeel@aurora.edu. If for any reason I feel the need for counseling, I may contact Cathi Hendricks
Counseling Center at Aurora University at (630)-844-5406 or by email at chendric@aurora.edu.
I understand that I have the right to refuse to participate in this study. I also understand that if I do agree
to participate, I have the right to change my mind at any time and stop my participation without penalty.
My signature below indicates that I have given my informed consent to participant in the described study.
My signature also indicates that:
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I am at least 18 years of age.
I have been given the opportunity to ask all and any questions about the project and my
participation.
I have been permitted the time to read this document.
I have received a copy of my consent form.
I am legally able to provide consent.
I have to the best of my knowledge and belief have no physical or mental illness or weakness that
would be adversely affected by my participation in the study.
CONSENT
I have read the above information. I have received a copy of this form. I agree to participate in this study.
Participant’s signature ______________________________ Date _________
Researcher’s signature _____________________________ Date___________
IRB Consent Form – Long Version December 2014