Title of Project: (Insert title of project)
You are invited to participate in a research study conducted by (insert name of
student investigator), under the supervision of (insert name of Professor and
department) of the University of Waterloo, Canada. The objectives of the
research study are (objectives of study). The study is for a Senior Honour’s
thesis.
If you decide to volunteer, you will be asked to complete a x-minute online survey
that is completed anonymously. Survey questions focus on (insert the
focus/type of questions that will be asked). Participation in this study is
voluntary. You may decline to answer any questions that you do not wish to
answer and you can withdraw your participation at any time by not submitting
your responses. There are no known or anticipated risks from participating in
this study.
It is important for you to know that any information that you provide will be
confidential. All of the data will be summarized and no individual could be
identified from these summarized results. Furthermore, the web site is
programmed to collect responses alone and will not collect any information that
could potentially identify you (such as machine identifiers).
****If using Survey MonkeyTM include something similar to, “This survey uses
Survey MonkeyTM which is a United States of America company. Consequently,
USA authorities under provisions of the Patriot Act may access this survey data.
If you prefer not to submit your data through Survey MonkeyTM, please contact
one of the researchers so you can participate using an alternative method (such
as through an email or paper-based questionnaire). The alternate method may
decrease anonymity but confidentiality will be maintained.” *****
If you wish to participate, please visit the Study Website at www.myurl.ca.
The data, with no personal identifiers, collected from this study will be maintained
on a password-protected computer database in a restricted access area of the
university. As well, the data will be electronically archived after completion of the
study and maintained for two years and then erased.
Should you have any questions about the study, please contact either (insert
name and contact information for student investigator) or (insert name and
contact information for faculty investigator). Further, if you would like to
receive a copy of the results of this study, please contact either investigator.
I 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 feel
free to contact Dr. Maureen Nummelin in the Office of Research Ethics at 1-519888-4567, Ext. 36005 or maureen.nummelin@uwaterloo.ca.
Thank you for considering participation in this study.
**** If the above is used for the introduction page of a web-survey, then do
not include the sentence with the link to the survey and add the following
to the end of the information page****
Consent to Participant
With full knowledge of all foregoing, I agree, of my own free will, to participate in
this study.
[insert check box or radio button] "I agree to participate."
[insert check box or radio button] "I do not wish to participate (please close
your web browser now)."