Details:This is a two-part assignment.Part 1-Create an informed consent form, 500-750 words,that you might use in practice. Find some examples or see the templates I have attachedPart 2 –Find someon

Instructions: Carefully address the directions in that are specified in red in each section. This document is very important and it represents you, your chair, and the University; therefore, please pay close attention to detail. Ensure there are no spelling or grammatical errors. The form should be written below the 9th grade reading level in layman’s terms (for example an 8.9 is sufficient). Evaluate the readability using the calculator below, and provide a screenshot of the readability results as a part of your IRB submission.

http://www.readabilityformulas.com/flesch-grade-level-readability-formula.php

http://www.online-utility.org/english/readability_test_and_improve.jsp

Delete the text above before submitting the form for IRB review.

INFORMED CONSENT FORM

CONSENT FORM

Title of your study here

INTRODUCTION

The purposes of this form are to provide you (as a parent) information that may affect your decision as to whether or not your child should participate in this research, and to record your consent of those who agree to be involved in the study.

RESEARCH

(Identify your Name, Title (doctoral student, faculty member, staff member), College of Principal Investigator) has invited your participation in a research study a

I am completing this research as part of my doctoral degree (if applicable, otherwise delete)

STUDY PURPOSE

The purpose of the research is to... (Describe the justification for the research including how your research will add value in layman’s terms)

ELIGIBILITY

Your child will be eligible to participate in this research if he/she:

1. (List all inclusion criteria)

2.

Your child will not be eligible to participate in this research if he/she:

1. (List all exclusion criteria)

2.

DESCRIPTION OF RESEARCH ACTIVITY

If you decide to allow your child to participate, then as a study participant your child will be asked to:

1. (List each activity, include location and duration of each activity)

2.

3.

(Include that participants can skip questions if the study involves a survey, interview, or focus group).

Approximately (number) of subjects will be participating in this research study.

RISKS

If you decide to allow your child to participate in this research study, then he/she may face some risks such as: (describe potential risks in layman’s terms).

To decrease the impact of these risks, your child can:

(Examples - skip any item in the survey, and/or, stop participation at any time, and/or, refuse to answer any interview question, etc.).

If applicable, list resources that will be provided (Example – studies with activities that may result in emotional distress require a list of free resources-list the resources in this area).

BENEFITS

If you decide to allow your child to participate direct benefits to your child are: (list possible direct benefits)

If you decide to allow your child to participate indirect benefits to your child are: (list possible indirect benefits)

CONFIDENTIALITY

All information obtained in this study is strictly confidential unless disclosure is required by law. The results of this research study may be used in reports, presentations, and publications, but the researchers will not identify your child. In order to maintain confidentiality of your child’s records, name of investigator will...

(Indicate specifically how you will keep the names of the participants confidential, the use of subject codes, or numerical identifiers. "Confidentiality will be maintained" is not acceptable).

The people who will have access to your child’s information are: (myself, and/or, my dissertation chair, and/or, other researchers, and/or, my dissertation committee, etc.)

Audio recording: (If applicable)

I would like to use a voice recorder to record your child’s responses. Your child (can, or, cannot) still participate if he/she does not wish to be recorded. Briefly describe how the participants’ identity will be protected.

Video recording: (If applicable)

I would like to use a video camera to record your child’s actions. Because this tape will show who your child is, these extra steps will be taken: (describe added security measures, such as how tapes will be securely transported, labeled, stored, deleted, etc.)

Your child (can, or, cannot) still participate if he/she does not wish to be recorded. Briefly describe how the participants’ identity will be protected.

I will secure your child’s information with these steps: (examples - locking it in a filing cabinet, and/or, securing the computer file with a password, and/or, using encryption on my computer).

I will keep your child’s data for 3 years. Then, I will delete electronic data and destroy paper data.

WITHDRAWAL PRIVILEGE

It is okay for you to decline your child’s involvement in this research study. Even if you and your child say yes now, you are free to say no later, and stop participating at any time. There will be no penalty to you or your child.

If your child decides to stop participating, he/she may do so by: (describe procedure to be followed if the participant wants to leave the study). If so, I (will use, or, will not use) the information I gathered from your child.

Your decision will not affect your child’s relationship with the researcher or otherwise cause a loss of benefits to which he/she might otherwise be entitled.

(If the subjects are learners, patients, clients or employees, advise that participation is voluntary and that nonparticipation or withdrawal from the study will not affect their grade, treatment, care, employment status, as appropriate).

I may stop your child’s participation, even if you did not ask me to, if: (describe circumstances or signs of distress that would lead researcher to stop participation).

COSTS AND PAYMENTS

There is no financial cost to your child as a participant in this study, nor is there payment for your child’s participation.

-OR-

There is no financial cost to the study participant, however, as a thank you for your willingness to participate, your child will be given (state type and amount of compensation).

COMPENSATION FOR ILLNESS AND INJURY

If you agree to allow your child to participate in the study, then your consent does not waive any of your legal rights. However, no funds have been set aside to compensate your child in the event of injury. (If more than minimal risk of foreseeable injury is anticipated, describe the facilities, medical treatment or services which will be made available in the event of injury or illness to a subject. Description may include on and off-campus services).

VOLUNTARY CONSENT

Any questions you have concerning the research study or your child’s participation in the study, before or after your consent, will be answered by (name of individual, GCU email, and telephone number of PI. The name and contact information of co-investigators can be included as well).

If you have questions about your child’s rights as a subject/participant in this research, or if you feel your child has been placed at risk, you can contact the Chair of the Human Subjects Institutional Review Board, through the College of Doctoral Studies at [email protected]; (602) 639-7804.

This form explains the nature, demands, benefits and any risk of the research study. By signing this form you agree knowingly to assume any risks involved. Remember, your child’s participation is voluntary. Your child may choose not to participate or you can withdraw your consent and discontinue participation at any time without penalty or loss of benefit. In signing this consent form, you are not waiving any legal claims, rights, or remedies. A copy of this consent form will be given (offered) to you.

Your signature below indicates that you consent to your child’s participation in this study.

___________________________ _________________________ ____________

Parent Signature Printed Name Date

Child’s Printed Name­­­­­­­­­­­­ ­­­­________

___________________________ _________________________ ____________

Other Signature Printed Name Date

(if appropriate)

INVESTIGATOR’S STATEMENT

"I certify that I have explained to the above individual the nature and purpose, the potential benefits and possible risks associated with participation in this research study, have answered any questions that have been raised, and have witnessed the above signature. These elements of Informed Consent conform to the Assurance given by Grand Canyon University to the Office for Human Research Protections to protect the rights of human subjects. I have provided (offered) the parent/guardian a copy of this signed consent document."

(Your signature indicates that you have ensured the participant has read, understood, and has had the opportunity to ask questions regarding their participation)

Signature of Investigator______________________________________ Date_____________