ࡱ> D_Ck !bjbjZ Z 0>8cb8cbqPT T 8Tp$ .4$I!#4ZZZdZZZ:,Z'``F 0 P $f$Z$Z,Z` $T B : CONSENT TO PARTICIPATE IN RESEARCH (Information Sheet) Project Title: (Insert title) Researcher(s): (Insert name of researcher(s)) Faculty Sponsor: (Include if the research is being conducted by a student) Introduction: For faculty or staff project state the following: You are being asked to take part in a research study being conducted by (researchers name), a faculty (or staff) member in the Department of (insert department) at Loyola University of Chicago. For a student project state the following: You are being asked to take part in a research study being conducted by (student name) for a (indicate whether this is a class project, thesis, dissertation) under the supervision of (faculty sponsor) in the Department of (insert department) at Loyola University of Chicago. You are being asked to participate because (explain why the person is being asked to participate. For example, if the person is being asked because he or she is a member of a particular group, has had a particular experience, or possesses certain characteristics, explain this here. When appropriate, give the approximate number of participants in the study and describe any exclusion criteria, e.g., age limit, health restrictions, etc.). Read this form carefully and ask questions you have before deciding to participate in the study. Purpose: The purpose of this study is (explain the research question or purpose in lay language). Procedures: If you agree to be in the study, you will be asked to: Explain all tasks and procedures in a language that a lay person can understand and in sufficient detail. For example, if the participants will be asked to participate in an interview, explain the subject matter of the interview, the topic areas that will be covered or types of questions that will be asked, how long it will take, where it will be held, etc. If the interview will be audiotaped or videotaped, state this. Tell the participants approximately how many people will be involved in the study If the research involves more than one procedure, (i.e. an interview and a survey), use bullet points to list and explain each procedure separately. If the research involves different experimental groups, explain how participants will be assigned to groups. If there is deception, a debriefing procedure will be needed. See the IRB website for a debriefing template. Risks/Benefits: Explain any foreseeable risks or discomforts. If there are no foreseeable risks, simply state: There are no foreseeable risks involved in participating in this research beyond those experienced in everyday life. Explain any benefits to the participant or to society. If the participant will not benefit directly, state: There are no direct benefits to you from participation, but (indicate how the results may be helpful to others or to society). Financial compensation should not be discussed here, but should be in a separate section. Compensation: (optional section) Include this section only if participants will be compensated in some way, (e.g., money, gift certificate, extra credit for a class, etc.). Describe the amount or nature of the compensation, when it will be received, and indicate how compensation will be handled if they withdraw. If compensation includes a drawing or raffle, note the odds of winning. Costs: (optional section) Include this section only if there are special costs to the participant for participation, (e.g., the participants must pay for an activity, etc. In this case, describe the anticipated costs). Alternatives: (optional section) Include this section only if this study involves an intervention or a diagnostic procedure and there are alternatives that the person may consider. In this case, explain the alternatives to participating in the research. For example, if there are other interventions or diagnostic procedures that the person may choose, describe them. Confidentiality: Explain the degree to which information gathered will be confidential and explain how it will be kept confidential, (i.e. if data will be coded so that no names appear on any questionnaires, explain the coding system). If there are limits to confidentiality, explain these, (e.g., if you are a licensed professional and thus required to report child/elder abuse or neglect, this should be disclosed if the study is likely to elicit reportable information; if others, besides the researcher(s), will have access to the data indicate who will have access, etc.). If de-identified data will be shared to meet open source standards, note this and describe the steps that will be taken to ensure confidentiality and any limits to confidentiality. If focus groups are part of the procedure, please note that you will ask everyone to keep everything said during the focus group confidential, but confidentiality cannot be guaranteed. If audio or video recordings will be made during the research, explain how the recordings will be stored and what will happen to the recordings at the conclusion of the research. Voluntary Participation: Participation in this study is voluntary. If you do not want to be in this study, you do not have to participate. Even if you decide to participate, you are free not to answer any question or to withdraw from participation at any time without penalty. (If participants currently have a relationship with the researcher or are receiving services from the cooperating research institution, state that their decision to participate or not will have no affect on their current relationship, the services they are currently receiving, etc.) Contacts and Questions: If you have questions about this research study, contact (insert name of researcher) at (insert business phone number or email). If this is a student project, give contact information for both the student researcher and the faculty sponsor, (e.g. If you have questions about this research project or interview, feel free to contact___ at___ or the faculty sponsor___ at___.). If you have questions about your rights as a research participant, you may contact the Loyola University Office of Research Services at (773) 508-2689. You will be given a copy of this form to keep for your records. Revision Date: XX/XX/202X (Each time a new version of this form is submitted for review, this date must be updated. 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