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

This template is for surveys that are confidential, not anonymous- the survey or instrument will include participants’ names.

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

Title of your study here

INTRODUCTION

The purposes of this form are to provide you (as a prospective research study participant) information that may affect your decision as to whether or not to participate in this research and to record the 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.

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

You are eligible to participate in this research if you:

1. (List all inclusion criteria)

2.

You are not eligible to participate in this research if you:

1. (List all exclusion criteria)

2.

DESCRIPTION OF RESEARCH ACTIVITY

If you decide to participate, then as a study participant you 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 participate in this research study, then you may face some risks such as: (describe potential risks in layman’s terms)

To decrease the impact of these risks, you 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 participate direct benefits to you are: (list possible direct benefits)

If you decide to participate indirect benefits to you 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 you. In order to maintain confidentiality of your 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 information are: (myself, and/or, my dissertation chair, and/or, other researchers, and/or, my dissertation committee, etc.).

I will secure your 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 data for 3 years. Then, I will delete electronic data and destroy paper data.

WITHDRAWAL PRIVILEGE

It is ok for you to decline to participate in this research study. Even if you say yes now, you are free to say no later, and stop participating at any time, there will be no penalty to you.

If you decide to stop participation, you 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 you.

Your decision will not affect your relationship with Grand Canyon University or otherwise cause a loss of benefits to which you 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 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 you as a participant in this study, nor is there payment for your participation.

-OR-

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

COMPENSATION FOR ILLNESS AND INJURY

If you agree 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 you 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 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 rights as a subject/participant in this research, or if you feel you have 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 clicking “I Agree’ you confirm that you are 18 years or older, understand the content of this form, and agree to participate in this study.

----I Agree ---- I Do Not Agree