Information and Consent Form for Course-based Lab Projects TITLE OF PROJECT

Information and Consent Form for Course-based Lab Projects
This research study is being conducted by [students’ names] under the supervision of [professor], as part
of the course assignment in [course name] in the [Department/School] at Queen’s University.
What is this study about? The purpose of this research is to [purpose plus a sentence or two of
How long will it take? The study will require [number of visits and duration per visit].
Are there any risks in this study? State only those that apply: 1) [There are no known physical,
psychological, economic, or social risks associated with this study] or 2) [The only known risk in this study
is that we will have you do/we will be doing and there is a slight/moderate/real risk that it could
hurt/causing bruising/cause a skin irritation that is only temporary/might last a couple of hours], or 3)
[The only known risk is that you will be asked to complete a physically demanding task which could result
in physical pain/muscle soreness or some discomfort]. If you experience any discomfort/pain/headache
that lasts longer than a couple of hours, please contact the student researcher immediately and/or
contact the professor.
Is my participation voluntary? Yes. Although it would be greatly appreciated if you would complete all
of the testing procedures, you should not feel obliged to and you are free to withdraw at any time.
What will happen to my responses? Your personal information will be kept confidential. Only [myself
and my supervisor or the research team or authorized persons] will have access to this information. All
identifiable information will be stored in a secure location. Code numbers will be used to mask your
identify when the project is presented in class or published in reports or shown in presentations. If
pictures are taken, your face will be [blurred/covered] to prevent your recognition. If a video is to be
displayed, you will be asked to give written permission to show your image before it will ever be used as
part of presentations.
Will I be compensated for my participation? No. This is non-funded research. We greatly appreciate
your willingness to volunteer your time to help [me/us] with [my/our] research project.
Who can I contact if I have any questions or concerns? In the event that you have any questions about
this research, please feel free to contact the researcher at [email of a student] or course professor, Dr.
[Professor] (613-533-????) at [email]. If you have any ethical concerns or complaints, you may contact
the Chair of the Queen’s University General Research Ethics Board at 1-844-535-2988 or
Written Consent
By signing below, I am verifying that: I have read the Letter of Information and had it explained to me. I
am aware that I can withdraw my participation in this study at any time [and request any information
collected about me be removed - include this statement only if this is true]. I know my personal
information will be kept confidential, and that this information will not be released without my
permission. I know who I should contact regarding questions about this research or if I should have any
ethical concerns about my participation or how the research was conducted.
Participant’s Name __________________________
Signature of Participant
Confirmation by Student Researcher
< My initials below indicate whether I am willing to have my picture/image shown in presentations>
<I am a) NOT willing ____ b) willing ____to have my image shown in a presentation>