As part of this project, we would like to make a photographic, audio, and/or video recording of this interview. We would like you to
indicate below what uses of these records you are willing to consent to. This is completely up to you. We will only use the records in
ways that you agree to. In any use of these records, neither your name nor any identifying information will be associated with your
interview material. No material will be used without your explicit consent.
1. The records can be studied by the research team for use in the research project.
2. The records can be used for scholarly publications.
3. The records can be shown at meetings of researchers interested in the study of information or information technology.
4. The records can be shown in classrooms to students.
5. The records can be shown in public presentations to non-scholarly, non-research groups.
Our photos __________ Audio __________ Your photos_______
You are invited to participate in a user test of our product game application prototype. We hope to learn efficient ways of creating a
game and accessing game features during play. You were selected as a possible participant in this study because you represent a
person familiar with the game and have prior experience with the game without any sort of electronic assistance. If you decide to
participate, we willobserve your interaction with our prototype as well as record your background information with the game. We will
present you with a prototype and ask you to perform certain functions with it. We expect to take about 20 minutes, and you will be
asked to attempt features and then analyse your thoughts on their ease of use. We hope you will not experience any discomfort, but
potential risks include eye strain from reading text on a miniature screen and potential soreness from repeated motions. By
improving the game in an interative cycle of revisions, we hope to optimize the experiene o f game users.
Any information that is obtained in connection with this study and that can be identified with you will remain confidential and will be
disclosed only with your permission. Any information released to third parties will be restricted to signed agreements with regard to
recorded audio/video media.
Your decision whether or not to participate will not prejudice your future relation with Team Treo. If you decide to participate, you are
free to discontinue participation at any time without prejudice.
You are making a decision whether or not to participate. Your signature indicates that you have read the information provided above
and have decided to participate. You may withdraw at any time without penalty or loss of benefits to which you may be entitled after
signing this form should you choose to discontinue participation in this study.
I freely and voluntarily consent to participate in this study. I understand that I may withdraw my consent and discontinue my
participation at any time.
I have read and understood the foregoing and received a copy of this form. You will be offered a copy of this form to keep.
Participant Signature: ________________________________Date:__________________
Please print name:_______________________________________
Contact:
Reid Hironaga (408) 981-0805
rhironaga (at) berkeley (dot) edu
This refers to any photos taken by you of which you have given us copies or are accessible online with use restrictions, if any. You
can specify different uses for different photos.