SAMPLE CONSENT FORMS
TEMPLATE F: STUDENT INVESTIGATOR - INFORMED CONSENT
NOTICE AND ADULT SUBJECTS
University of North Texas Institutional Review Board
Informed Consent Notice
Before agreeing to participate in this research study, it is important that you read and understand
the following explanation of the purpose, benefits and risks of the study and how it will be
conducted.
Title of Study: ______________________________________________________
Student Investigator: ______________________, University of North Texas (UNT)
Department of ____________. Supervising Investigator: ______________________
Purpose of the Study: You are being asked to participate in a research study which involves
(describe the project in language the subject can easily understand).
Study Procedures: You will be asked to (explain specifically what the subjects will be asked to
do) that will take about (specify the total time commitment) of your time.
Foreseeable Risks: The potential risks involved in this study are (include any foreseeable risks
or discomforts which the subject may experience or state that “No foreseeable risks are involved
in this study.”).
Benefits to the Subjects or Others: We expect the project to benefit you by (include any
foreseeable benefits to the subjects or state that “This study is not expected to be of any direct
benefit to you, but we hope to learn more about ____” to explain how the study may benefit
others or may contribute to your field of study. Use “may” or “is expected to” because IRB
studies cannot guarantee results).
Compensation for Participants: None OR You will receive (describe any payment or other
compensation) as compensation for your participation (include the timing for payment and any
conditions for receipt of such compensation, i.e. is payment conditioned upon on completing all
tasks requested or is there partial payment for completing some of the tasks. If extra credit is
offered for a course, an alternative non-research activity with equivalent time and effort must be
offered. If extra credit will be offered to some groups of students but not offered to others,
submit a separate informed consent notice for each situation.).
Office of Research Integrity & Compliance
University of North Texas
Last Updated: August 9, 2007
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Procedures for Maintaining Confidentiality of Research Records: (Describe the methods you
will take to protect your subjects' confidentiality or anonymity, such as maintaining any
identifying information and coded survey results in separate locations.) The confidentiality of
your individual information will be maintained in any publications or presentations regarding
this study. (If you will be conducting an internet survey, please insert the following statement
here: Confidentiality will be maintained to the degree possible given the technology and
practices used by the online survey company. Your participation in this online survey involves
risks to confidentiality similar to a person’s everyday use of the internet.)
Questions about the Study: If you have any questions about the study, you may
contact (insert name of Student Investigator) at (insert contact information) or
(insert name of Supervising Investigator) at (insert contact information).
Review for the Protection of Participants: This research study has been
reviewed and approved by the UNT Institutional Review Board (IRB). The UNT
IRB can be contacted at (940) 565-4643 with any questions regarding the rights of
research subjects.
Research Participants’ Rights:
Your participation in the survey confirms that you have read all of the above and
that you agree to all of the following:
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(Insert name of Student Investigator) has explained the study to you and
you have had an opportunity to contact him/her with any questions about
the study. You have been informed of the possible benefits and the
potential risks of the study.
You understand that you do not have to take part in this study, and your
refusal to participate or your decision to withdraw will involve no penalty
or loss of rights or benefits. The study personnel may choose to stop your
participation at any time.
(If recruiting students as participants, insert the following statement here)
Your decision whether to participate or to withdraw from the study will
have no effect on your grade or standing in this course.
You understand why the study is being conducted and how it will be
performed.
You understand your rights as a research participant and you voluntarily
consent to participate in this study.
You understand you may print a copy of this form for your records.
Office of Research Integrity & Compliance
University of North Texas
Last Updated: August 9, 2007
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