NORTH CAROLINA AGRICULTURAL AND TECHNICAL STATE UNIVERSITY
INFORMED CONSENT TO PARTICIPATE IN AN ANONYMOUS RESEARCH SURVEY
If your research involves using an anonymous survey and there is no risk to participants,
a simple cover letter will be sufficient to gain your subjects’ informed consent to
participate. The letter template below includes all the elements needed in an informed
consent document. Please note that minor text changes may be made to customize this
letter to your needs, but no element of consent should be omitted.
For Internet surveys, this letter must be the opening page of your survey.
Remember: Replace or remove all RED TYPE before distributing the letter.
Study Title:
Principal Investigator:
Faculty Advisor: [Delete if not applicable.]
Dear Respondent,
I am inviting you to participate in a research study about xxxx. [This research project is
funded by xxxx.] You are being asked to participate because you are xxxx [include all
criteria for participation, if any]. The procedure involves completing a survey that will take
approximately xx minutes. The survey questions will be about xxxx. Through your
participation I hope to understand xxxx. You must be at least 18 years old to participate.
To protect your confidentiality, the survey will not contain information that will personally
identify you, and I will not ask for your name. All information collected in this study will be
kept completely confidential to the extent permitted by law.
[There should be minimal to no risk for a survey; however, if some of the questions may
be sensitive or very personal, state that.]
For Paper Survey: If you do not feel comfortable giving your survey to me (or your
instructor), you may also [mail it to ____, drop it off at X office, etc.]. If you do not wish to
participate, you may turn in a blank survey. I do not anticipate any risks from participating
in this research.
If you are collecting email addresses in an otherwise anonymous study, such as for a
drawing, include the following statement: Your email address will be requested so that
we _____. However, it will be stored separately from any data collected in the study. [For
collecting email addresses, it is ideal for the end of the survey to direct the participants to
a separate location so that their email addresses are not directly tied to their survey
answers. An alternate option is to include your email address and have the participants
send their email address to you that way.]
This project has been approved by the Institutional Review Board (IRB) at North Carolina
A&T State University.
Revised 08/2013
Page 1 of 2
This box must remain for
office use. Do not remove or
reposition.
NORTH CAROLINA AGRICULTURAL AND TECHNICAL STATE UNIVERSITY
INFORMED CONSENT TO PARTICIPATE IN AN ANONYMOUS RESEARCH SURVEY
Your participation is voluntary and there is no penalty if you do not participate. You may
stop the survey at any time or skip any questions you do not wish to answer.
If you have any questions about completing the questionnaire or about being in this
study, you may contact me at _______. You may also contact my research advisor at
________. If you have any study-related concerns or any questions about your rights as
a research study participant, you may contact the Office of Research Compliance and
Ethics at North Carolina A&T State University at (336) 285-2961.
By completing this survey, you are indicating that you at least 18 years old, have read
this document, have had any questions answered, and voluntarily agree to take part in
this research study. You may keep this form for your records. [Or for Internet surveys:
You may print a copy of this consent agreement for your records.]
Sincerely,
Justin Time
Associate Professor, North Carolina A&T State University
Revised 08/2013
Page 2 of 2
This box must remain for
office use. Do not remove or
reposition.