Title of Project:
(insert project title)
Student Investigators:
(insert names of student investigators)
(insert department), University of Waterloo
(insert at least one email contact)
Faculty Supervisor:
(insert name, contact information, department)
Summary of the Project:
The purpose of this proposed project is to create a social-networking website that allows
participants of sports to find teammates or opponents to play their chosen sport with, in their
chosen city. The site will also allow someone to select a teammate or opponent based on similar
skill level. In order to design a successful website, interviews will be conducted with potential
users to determine their preferences when using such a website.
Procedure:
Your participation in this study will involve answering a prepared set of questions regarding how
you currently set up sport matches with other participants and what type of features or content
you feel would be necessary or desirable in a successful sports-based social networking
website.
This interview will take approximately 30 minutes.
With your permission the interview will be audio recorded. You may decline to answer questions
if you wish. You may withdraw your participation at any time without penalty by advising one of
the student investigators.
Risks and Benefits:
There are no known or anticipated risks from participation in this study. Also, there are no direct
benefits to you for participating in this research. However, the results of this research may
contribute to the knowledge base of Human Systems Engineering research and to lead to the
development of improved usability and effectiveness of future sports-based social networking
websites.
Confidentiality and Data Security:
All information you provide is considered completely confidential. Your name will not appear in
any publication resulting from this study; however, with your permission anonymous quotations
may be used. In these cases participants will be referred to as Participant 1, Participant 2, … (or
P1, P2, … ). Data, including audio recordings, collected during this study will be retained
indefinitely in locked drawers or on password protected computers in a secure location
accessible only to researchers associated with this project. Electronic data will be de-identified
before being stored.
You will be explicitly asked for consent for the use of audio data for the purpose of reporting the
study’s findings. If consent is granted, these data will be used only for the purposes associated
with teaching, scientific presentations, publications, and/or sharing with other researchers and
you will not be identified by name.
Contact Information and Research Ethics Clearance
If you have any questions about participation, or would like additional information to assist you in
reaching a decision about participation, please ask one of the student investigators now or
contact (insert name and UW phone number) or via email at (insert email). Also you may
contact our faculty supervisor (insert name and department) at the University of Waterloo at
(519) 888-4567 extension xxxxx or (insert email).
We would like to assure you that this study has been reviewed and received ethics clearance
through a University of Waterloo Research Ethics Committee. However, the final decision about
participation is yours. If you have any comments or concerns resulting from your participation in
this study, please contact Dr. Maureen Nummelin, the Director, Office of Research Ethics, at 1519-888-4567, Ext. 36005 or maureen.nummelin@uwaterloo.ca.
Thank you for your assistance in this project.
CONSENT TO PARTICIPATE IN A RESEARCH STUDY
By signing this consent form, you are not waiving your legal rights or releasing the investigator(s)
or involved institution(s) from their legal and professional responsibilities.
Project: (insert title of project)
I have read the information presented in the information letter about a study being conducted by
<student 1>, <student 2>, and <student 3> of the (insert department) at the University of
Waterloo conducted under the supervision of Professor (insert name). I have had the
opportunity to ask any questions related to this study, to receive satisfactory answers to my
questions, and any additional details I wanted.
I am aware that I may allow excerpts from the interview to be included in presentations and
publications related to this project, with the understanding that any quotations will be
anonymous.
I am aware that I may allow audio recordings to be used in presentations and publications
related to this project with the understanding that I will not be identified by name.
I am aware that I may withdraw my consent for any of the above statements or withdraw my
study participation at any time without penalty by advising the researcher.
This project has been reviewed by, and received ethics clearance through a University of
Waterloo Research Ethics Committee. I was informed that if I have any comments or concerns
resulting from my participation in this study, I may contact the Director, Office of Research Ethics
at 519-888-4567 ext. 36005.
Please
Please Initial
Circle One Your Choice
With full knowledge of all foregoing, I agree, of my own free
will, to participate in this study.
YES NO
_______
I agree to the interview being audio recorded.
YES NO
_______
I agree to let my conversation during the study be directly
quoted, anonymously, in presentation of the research results.
YES NO
_______
YES NO
_______
I agree to let audio recordings be used for presentation of the
research results.
Participant Name: ______________________________________(Please print)
Participant Signature: ___________________________________
Witness Name: ________________________________________ (Please print)
Witness Signature: _____________________________________
Date: ________________________________________________