Sample Informed Consent Form

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Informed Consent
Self-Directed Learning Skills: Self-Rating Scale
The purpose of this study is to explore and describe graduate students perceptions of their selfdirected learning skills. This self-rating scale is designed to gauge your perceptions about how
various self-directed learning skills (Knowles, 1978) fit as a personal attribute. Knowing such
information may help you identify those areas of strength that can be used in your self-study
efforts and those that may need to be enhanced in various ways.
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You must be 18 years or older to participate in this survey.
Completing the survey is voluntary and will not affect your grade in this course.
You may choose not to complete the survey. Simply return the survey when they are
collected.
Risks of participation in the survey are not greater, considering probability and magnitude,
than those ordinarily encountered in daily life.
It will take you about 5 minutes to complete the survey.
By participating in this study, you may add to existing the knowledge base on how graduate
students approach their learning and to the literature on self-directed learning.
Information will be used in presentations and publications.
Your name will not be associated with your answers.
All your answers will be grouped with the answers of others.
The data will not be coded in any identifiable way.
All survey data will be reported in aggregate.
All survey responses will be stored in a locked file cabinet.
All survey responses will be destroyed upon completion of the study.
If you have any questions about your rights as a research subject, please contact the
University of Hartford Human Subjects Committee (HSC) at 860.768.5371. The HSC is a
group of people that reviews research studies and protects the rights of people involved in
research.
Thank you for participating. If you have any questions about this survey, you may contact:
_______________, Ed.D.
Assistant Professor
Department of Educational Leadership
Phone: 860-768-xxxx
Email: [email protected]
DO NOT place your name on this sheet or the survey.
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