Sample/template SBS Consent Forms/Scripts
Below are templates of consent materials for typical social & behavioral sciences
research projects:
 Oral Consent Script (when IRB has approved waiver of written and signed
Informed Consent Form); examples for Student Research and Non-student
Research
 Informed Consent Form, requiring signature of participant – Outline Format to
assure that all elements of Informed Consent are Captured
 Child assent form
 Parent/legal guardian consent form
1. Sample Oral Consent Script – SBS Student Project
[Note that although the verbal consent is being sought, participants should be given a
copy of the script that includes the researcher’s and IRB’s contact information.]
Instructions are in red; bolded items must be included.
Before submission to the IRB: remove instructions and any bold emphasis
[Study Title]
[PI Name]
[Student Investigator Name]
Hello. My name is [insert name]. I am a graduate student in the Department/School of
[add department or School] at AUB. I would like to invite you to participate in a
research study about [describe project in non-technical language; explain purpose of
study].
Before we begin, I would like to take a few minutes to explain why I am inviting you to
participate and what will be done with the information you provide. You will be asked to
[describe procedure, such as “participate in a short interview” or “take several memory
tests.” Include types of questions that will be asked; describe alternative procedures, if
any] Please stop me at any time if you have questions about the study.
I am doing this study as part of my studies at AUB. I will be [add what you will be doing
as part of data collection, e.g. interviewing x number of people, asking y number of
people to complete the tests, etc.] and will use the information as the basis for my
[explain as course research requirement, thesis, dissertation.] I may also use this
information in articles that might be published, as well as in academic presentations.
Your individual privacy and confidentiality of the information you provide will be
maintained in all published and written data analysis resulting from the study. [State any
conditions for confidentiality of data here.] [If identities will be disclosed, provide
details, e.g. with your permission your identity will be made known in the written
materials resulting from this study, or pseudonyms will be used with any quotes
attributed to an individual.] [N.B. If you will be sharing the information with other
researchers or putting data in archives, etc, explain your plans here.]
Your participation should take approximately [insert duration.] Please understand your
participation is entirely on a voluntary basis and you have the right to withdraw your
consent or discontinue participation at any time without penalty. [If you will be
asking any personal or sensitive questions, state as much here.] [State any foreseeable
risks to participants here, including steps you will take to minimize these risks. If the
risks are minimal, state so.] The benefits which may reasonably be expected to result
from this study are [state any potential direct benefits here. If there are no direct
benefits, state as such.] You will receive [insert reimbursement or incentive for
participation; explain any proration of payment if the subject withdraws for completing
study, if any; where there is no payment or compensation, state as such] as payment for
your participation.
If at any time and for any reason, you would prefer not to answer any questions, please
feel free to skip those questions [interview – say ‘skip this question’; paper form, just
skip the question]. If at any time you would like to stop participating, please tell me. We
can take a break, stop and continue at a late date, or stop altogether. You will not be
penalized for deciding to stop participation at any time [if prorating payment, make clear
impact of deciding to withdraw from participation.]
[If you will be tape recording or videotaping the subject include the following:]
I would like to tape record/video tape this interview so as to make sure that I remember
accurately all the information you provide. I will keep these tapes in [state where you will
keep them] and they will only be used by [state who will have access to the tapes]. [If
you will be sharing taped data with other researchers and/or archiving data, state whether
identifiers other than voice or face will be included.] [Explain what will happen to the
tapes after the research done is completed.] [If participants may participate without being
taped, state so.]
If you have any questions, you are free to ask them now. If you have questions later, you
may contact me at [add your contact information, including name, email address, phone
number, etc.]. If you have questions about your rights as a participant in this research,
you can contact the following office at AUB: [add contact information for SBS IRB/IRB
Office, address, phone number, email.]
Are you interested in participating in this study?
Consent to Record Interview
(Question should be posed before any recording begins)
May I record this interview?
Consent to Quote from Interview
I may wish to quote from this interview either in the presentations or articles resulting
from this work. [If a pseudonym will be used, include this statement: A pseudonym will
be used in order to protect your identity, unless you specifically request that you be
identified by your true name.]
Do you all me to quote from this interview?
Consent to Use Name
There may be reasons for which you prefer that your true name be used in presentations
and articles related to this research.
Would you like your true name to be used in any oral presentations or written documents
resulting from this research?
[Note that if a participant agrees to have his or her name used, signed consent should be
obtained, including a separate signature line for participation, taping (where applicable),
and use of name. In such cases, add signature lines to this consent document. Remember
to always give a copy of the Consent Form to the participant.
2. Sample Oral Consent Script – SBS Non-student Project
[Note that although the verbal consent is being sought, participants should be given a
copy of the script that includes the researcher’s and IRB’s contact information.]
Instructions are in red; bolded items must be included.
Before submission to the IRB: remove instructions and any bold emphasis
[Study Title]
[PI Name]
Hello. My name is [insert name]. I am a researcher in the Department/School of [add
department or School] at AUB. I would like to invite you to participate in a research
study about [describe project in non-technical language; explain purpose of study].
Before we begin, I would like to take a few minutes to explain why I am inviting you to
participate and what will be done with the information you provide. You will be asked to
[describe procedure, such as “participate in a short interview” or “take several memory
tests.” Include types of questions that will be asked; describe alternative procedures, if
any] Please stop me at any time if you have questions about the study.
I am doing this study as part of my research at AUB. I will be [add what you will be
doing as part of data collection, e.g. interviewing x number of people, asking y number of
people to complete the tests, take surveys, etc.] and this collected information will be
used in published research as well as in academic presentations. Your individual privacy
and confidentiality of the information you provide will be maintained in all published
and written data analysis resulting from the study. [State any conditions for
confidentiality of data here.] [If identities will be disclosed, provide details, e.g. with your
permission your identity will be made known in the written materials resulting from this
study, or pseudonyms will be used with any quotes attributed to an individual.] [N.B. If
you will be sharing the information with other researchers or putting data in archives, etc,
explain your plans here.]
Participation should take approximately [insert duration.] Please understand your
participation is entirely on a voluntary basis and you have the right to withdraw your
consent or discontinue participation at any time without penalty. [If you will be
asking any personal or sensitive questions, state as much here, e.g. some of the interview
questions may ask about your personal behaviors; some of the pictures you will be asked
to look at may cause some distress, etc.] [State any foreseeable risks to participants
here, including steps you will take to minimize these risks. If the risks are minimal, state
so.] The benefits which may reasonably be expected to result from this study are [state
any potential direct benefits here. If there are no direct benefits, state as such. For
example, there are no direct benefits to for participating in this research, but you may be
helping others to better understand (fill in generalizable knowledge benefit).]
You will receive [insert reimbursement or incentive for participation; explain any
proration of payment if the subject withdraws for completing study, if any; if there is no
payment or compensation, state as such] as payment for your participation.
If at any time and for any reason, you would prefer not to answer any questions, please
feel free to skip those questions [interview – say ‘skip this question’; paper form, just
skip the question]. If at any time you would like to stop participating, please tell me. We
can take a break, stop and continue at a late date, or stop altogether. You will not be
penalized for deciding to stop participation at any time [if prorating payment, make clear
impact of deciding to withdraw from participation.]
[If you will be tape recording or videotaping the subject include the following:]
I would like to tape record/video tape this interview so as to make sure that I remember
accurately all the information you provide. I will keep these tapes in [state where you will
keep them] and they will only be used by [state who will have access to the tapes]. [If
you will be sharing taped data with other researchers and/or archiving data, state whether
identifiers other than voice or face will be included.] [Explain what will happen to the
tapes after the research done is completed.] [If participants may participate without being
taped, state so.]
If you have any questions, you are free to ask them now. If you have questions, concerns
or complaints about this research study later, you may contact me at [add your contact
information, including name, email address, phone number, etc.].
Are not satisfied with how this study is being conducted, or if you have any concerns,
complaints, or general questions about research or your rights as a participant, please
contact the AUB Social & Behavioral Sciences Institutional review Board (SBSIRB) at
AUB: [add contact information for SBS IRB/IRB Office, address, phone number,
email.]
Are you interested in participating in this study?
Consent to Record Interview
(Question should be posed before any recording begins)
May I record this interview?
Consent to Quote from Interview
I may wish to quote from this interview either in the presentations or articles resulting
from this work. [If a pseudonym will be used, include this statement: A pseudonym will
be used in order to protect your identity, unless you specifically request that you be
identified by your true name.]
Do you all me to quote from this interview?
Consent to Use Name
There may be reasons for which you prefer that your true name be used in presentations
and articles related to this research.
Would you like your true name to be used in any oral presentations or written documents
resulting from this research?
[Note that if a participant agrees to have his or her name used, signed consent should be
obtained, including a separate signature line for participation, taping (where applicable),
and use of name. In such cases, add signature lines to this consent document.]
Confirmation of Consent to Record Interview
(Question will be posed once recording has begun)
May I record this interview?
3. SBS SAMPLE CONSENT DOCUMENT – USING OUTLINE FORM
AUB
[Department/School]
[Name of PI and researchers]
Consent document
We are asking you to participate in a research study. Please read the information below and feel
free to ask any questions that you may have.
A. Project Description
1. In this study, you will [describe tasks/procedures that the subject will be engaging in.
If you will be asking any personal or sensitive questions, state as much here.]
2. The estimated time to complete this study is approximately [add expected time].
3. The research is being conducted with the goal of publication in [e.g. academic journal,
book,] and possibly presentation at academic conferences.
4. [Include any other additional information about the project and data collection here.
For example, if you will be sharing the information with other researchers or putting data
in public archives.]
5. [If subjects will be compensated, state the amount and terms of compensation. If
payments will be prorated if a subject withdraws from the study, state the terms.]
B. Risks and Benefits
Your participation in this study does not involve any physical risk or emotional risk to
you beyond the risks of daily life. [If risks are greater than minimal, please state those
risks here.] You have the right to withdraw your consent or discontinue participation at
any time for any reason. Your decision to withdraw will not involve any penalty or loss
of benefits to which you are entitled. Discontinuing participation in no way affects your
relationship with AUB.
The benefits of this study include [state any potential direct benefits to subjects here.] [If
no direct benefits so state: You receive no direct benefits from participating in this
research; however your participation does help researchers better understand (fill in
benefit to generalizable knowledge in field)]
C. Confidentiality
[State conditions for confidentiality of data here. For example, ‘Your name or other
identifiers will not be attached to your answers so that your confidentiality can be
maintained. Your privacy will be ensured in that all data resulting from this study will be
analyzed, written, and published in aggregate form.’]
Example:
To secure the confidentiality of your responses, your name and other identifying
information will never be attached to your answers. All codes and data are kept in a
locked drawer in a locker room or in a password protected computer that is kept secure.
Data access is limited to the Principal Investigator and researchers working directly on
this project. All data will be destroyed responsibly after the required retention period
(usually three years.) Your privacy will be maintained in all published and written data
resulting from this study. Your name or other identifying information will not be used in
our reports or published papers.
D. Contact Information
1) If you have any questions or concerns about the research you may contact [list
researcher’s contact information, including name, mailing address, telephone number,
and email address].
2) If you have any questions, concerns or complains about your rights as a participant in
this research, you can contact the following office at AUB:
Social & Behavioral Sciences Institutional Review Board
[add address, telephone, email for administrative contact]
E. Participant rights
Participation in this study is voluntary. You are free to leave the study at any time
without penalty. Your decision not to participate is no way influences your relationship
with AUB.
Do you have any questions about the above information? Do you wish to participate in this
study? [If written consent is required, please add a line below for the subject to sign and date.]
Example:
I have read and understand the above information. I agree to participate in the research study.
Participant: ____________________________ Date: _____________________
4. SBS Child Assent Form Template
AUB Social & Behavioral Sciences Assent to Participate in
Research
Study Title:
Researcher:
Sponsor: [if any]

You are being asked to be in a research study. Studies are done to find better
ways to treat people or to better understand how kids think about things or how
kids and adults may behave at different times.

This form will tell you about the study to help you decide whether or not you
want to participate.

You should ask any questions you have before making up your mind. You can
think about it and discuss it with your family or friends before you decide.

It is okay to say “No” if you don’t want to be in the study. If you say “Yes” you
can change your mind and quit being in the study at any time without getting in
trouble.

If you decide you want to be in the study, an adult (usually a parent) will also
need to give permission for you to be in the study.
1. What is this study about?
2. What will I need to do if I am in this study?
3. How long will I be in the study? [Insert expected duration of test, survey,
interview, etc. If there is a follow up portion of the study, make it clear there
are several sessions involved in this study.]
4. Can I stop being in the study?
You may stop being in the study at any time. [If there are limitations, such as you
may discontinue completing the test/survey at any time, but you must remain at your
desk in this room until the survey period ends.]
5. What bad things might happen to me if I am in the study? [MAKE RISK
DESCRIPTION APPROPRIATE TO LEVEL OF
UNDERSTANDING/AGE OF CHILD]
6. What good things might happen to me if I am in the study? [IF NO
DIRECT BENEFIT, SAY THAT]
7. Will I be given anything for being in this study? [IF ANY INCENTIVE,
MAKE CLEAR WHETHER IT IS GIVEN TO CHILD OR TO HIS
PARENT/GUARDIAN]
8. Who can I talk to about the study?
For questions about the study you may contact ___________________.
To discuss other study-related questions with someone who is not part of the research
team, you may contact the AUB Social & Behavioral Science Institution Review
Board at [INSERT PHONE NUMBER OR EMAIL ADDRESS]
Signing the assent form
I have read (or someone has read to me) this form. I have had a chance to ask questions
before making up my mind. I want to be in this research study.
AM/PM
Signature or printed name of subject
Date and time
Investigator/Research Staff
I have explained the research to the participant before requesting the signature above.
There are no blanks in this document. A copy of this form has been given to the
participant or his/her representative.
Printed name of person obtaining assent
Signature of person obtaining assent
AM/PM
Date and time
This form must be accompanied by an IRB approved parental permission form signed
by a parent/guardian.
5. AUB Social & Behavioral Sciences Parental Permission Template
Permission for Child to Participate in Research
Study Title:
Researcher:
Sponsor: [If applicable]
This is a permission form for your child/child for whom you are legal guardian to
participate in a research study. It contains important information about this study and
what to expect if you decide to permit your child/child for whom you are legal guardian
to participate.
Your child’s participation is voluntary.
Please consider the information carefully before you decide to allow your child to
participate. If you decide to permit participation, you will be asked to sign this form and
will receive a copy of the form.
Purpose: [describe in nontechnical terms the purpose of the research project,
include the types of questions or activities that the child will be asked to perform,
observe.]
Procedures/Tasks: [describe the procedures involved, mention audio or video
taping, if applicable and what will happen to the tapes after the study, e.g. shown at
scientific meetings, archived for a period of time and then responsibly destroyed,
etc.]
Duration:
[Insert the length of time the child will be involved in the study; if there is more than
one session, describe how many sessions and the length time for each session.]
Your child may leave the study at any time. If you decide to stop your child’s
participation in the study, there will be no penalty to you, or your child and you will not
lose any benefits to which you are otherwise entitled. Your decision will not affect your
future relationship, or that of your child, with AUB.
Risks and Benefits: [insert a description of all foreseeable risks to the child
participating in the research.] [Insert a description of any direct benefits that the
child might receive or gain by participation. Example: during this research your
child will be shown how to play a simple board game involving two people. Your
child will be permitted to keep this game as a thank you for participating in the
research. ]
Confidentiality:
[Insert full description of how privacy of information and data collected will be
preserved; how confidentiality of child’s participation will be protected. Explain
what will happen to the research data after the study is complete. If data will be
shared with other researchers at AUB or elsewhere disclose that information.]
Example:
Efforts will be made to keep your child’s study-related information confidential. All data
from this study will be maintained in a secure locked drawer in a locked office or on a
password protected computer. Data will only be reported in the aggregate. No names of
individual children will be disclosed in any reports or presentations of this research.
However, there may be circumstances where this information must be released. For
example, personal information regarding your child’s participation in this study may be
disclosed if required by law. Also, your child’s research data may be reviewed by the
following groups (as applicable to the research):

U.S. Office for Human Research Protections or other federal, state, or
international regulatory agencies, required;

The AUB Institutional Review Board or Office of Human Research Protections;

The sponsor, if any, or agency supporting the study.
After the conclusion of the study, the Principal Investigator will retain all original study
data in a secure location for at least three years to meet institutional archiving
requirements. After this period, data will be responsibly destroyed.
Incentives: [insert description of reimbursement or recruitment incentive or
participation incentive. If payment is prorated for partial participation in the
research, be clear about what payment schedule is. If there is no payment, state as
such. Make clear whether payment is made directly to the child e.g. your child will
be able to select a toy of nominal value from the study toy box for participating in
the project; or payment made to parent/legal guardian: you will receive $3.00 for
your child’s participation in the study.]
Participant Rights:
You may refuse to allow your child to participate in this study without penalty or loss of
benefits to which you are otherwise entitled. If you are a student or employee at AUB,
your decision about whether or not you allow your child to participate in this research
will not affect your grades or employment status.
If you choose to allow your child to participate in the study, you may discontinue his/her
participation at any time without penalty or loss of benefits. By signing this form, you do
not give up any personal legal rights you or your child may have as a participant in this
study.
The Social & Behavioral Institutional Review Board responsible for human subjects
research at AUB has reviewed this research project and found it to be acceptable,
according to applicable Lebanese and U.S. federal regulations and AUB policies
designed to protect the rights and welfare of participants in research.
Contacts and Questions:
For questions, concerns, or complaints about the study you may contact [Insert name of
PI/Investigator and phone or email where this person may be contacted.]
For questions about your child’s rights as a participant in this study or to discuss other
study-related concerns or complaints with someone who is not part of the research team,
you may contact the AUB Social & Behavioral Science Institutional Review Board
[INSERT PHONE AND EMAIL CONTACT INFORMATION]
Signing the consent form
I have read (or someone has read to me) this form and I am aware that I am being asked
to give permission for my minor child (or child under my guardianship) to participate in a
research study. I have had the opportunity to ask questions and have had them answered
to my satisfaction. I voluntarily agree to give permission for my child/child under my
guardianship to participate in this study.
I am not giving up any legal rights by signing this form. I will be given a copy of this
form.
Printed name of subject
Printed name of person authorized to give permission for
minor subject/participant
Signature of person authorized to give permission for minor
subject/participant (when applicable)
Relationship to the subject
Date and time
AM/PM
Investigator/Research Staff
I have explained the research to the parent or legal guardian of the child
subject/participant before requesting the signature(s) above. There are no blanks in this
document. A copy of this form has been given to the parent/legal guardian of the child
participant/subject.
Printed name of person obtaining permission
Signature of person obtaining permission
AM/PM
Date and time