The following research project description and informed consent form are   templates for all persons conducting research involving human participants at Millikin University. These forms are required of all "non-exempt" research projects, oral and written, and are strongly recommended for "exempt" research. Information that is in quotes is required to occur in the disclosure an consent form given to human participants. Underlined information must be included in verbatim.

"Your Project Title"

"Project Description"
"Using language that participants can easily understand, provide: (a) a brief description of the study, (b) those features of the study likely to affect the participant's willingness to take part (e.g., time requirements, invasive procedures, confidentiality agreement), (c) any risks or benefits to the participant, and (d) the researcher's responsibility to detect and remedy any harm. Typically the study description and consent form are in writing. When  the description and consent are to be presented orally, the researcher must still submit the project description and consent that they will read to participants. Even with oral consent, participants should sign a group sheet that states they have been provided with a study description and consent, and that they voluntarily agree to participate.  In special cases such as anonymous questionnaires, informed consent may be assumed without written consent or oral agreement. In these special cases, the above information is included in a cover letter and the returned questionnaire is taken as voluntary consent to participate.""Consent to Participate"  (Remove underlining in final copy)

 I have been informed about the nature of this study, and I voluntarily agree to participate in this study. I also give my consent that any data (specify type ( specify type: audiotaped, videotaped, and/or psychological test) collected as a result of my participation in this study may be used for educational and/or scientific purposes.

I understand that the responses I give will be considered confidential, reported only as group data, and that every possible effort will be made to preserve my anonymity regarding these data. (If anonymity can not be guaranteed, the consent form will indicate who will have access to the data, how the data will be stored, the duration the data will retained, and whether it will ultimately be destroyed).

I understand that I am free to discontinue my participation at any time, or refuse to answer any question, without penalty. I understand that none of my legal rights regarding negligence and the liability of Millikin University or its agents have been waived. I understand that if I have any questions regarding the study, I can contact (insert name of Principal Investigator with phone number). If I have any questions about my rights as a subject, I may contact Dr. Rene' Verry, Chair of the Millikin Institutional Review Board at 424-6398. I will be given a copy of this consent form to keep, and the researcher will keep another copy on file.

I affirm that I have read this entire statement, and that I have been given an
opportunity to ask any questions I may have regarding this form and this study.

_______________________________________________
Participant's/Legal Guardian’s Printed Name

_______________________________________________
Participant's/Legal Guardian’s Signature

Participant's Birthdate(MO/YR)_______ Date___________

_________________________________________________
Signature of Person Obtaining Consent & Title
(PI= Principal Investigator, CO=Co-investigator, RA= Research Assistant)

Consent form valid until:______.