邢唷��>� ��欹�Q ��@bjbjY覻� 0�;箵e;箵e8 �� eeeee��yyy8��}<�y鐯��$$$g@i@i@i@i@i@i@$贑�怓l岪e$"$$$岪ee��3�!�!�!$:e�e�g@�!$g@�!�!6�:�C=��pX$嘠��^(;S@窣0鐯�;�麱��麱8C=C=麱eW=�$$�!$$$$$岪岪: x$$$鐯$$$$��麱$$$$$$$$$ +: INSTITUTIONAL REVIEW BOARD Consent for Research Participation Study Title: [Title] Principal Investigator (PI): [Name], [Department], [Institution] Faculty Advisor: [Name], [Department], [Institution] PI Contact Info: [Phone], [Email] __________________________________________________________________ You are being asked to participate in a research study. The first section below highlights key information about this research for you to consider when making a decision whether or not to participate. Carefully consider this information and the more detailed information provided in the remainder of this document. Please ask questions about any of the information you do not understand before you decide whether to participate. KEY INFORMATION ABOUT THE RESEARCH STUDY Voluntary Consent. Taking part in this research project is voluntary. Research studies include only people who choose to take part. You don抰 have to participate and you can stop at any time. Purpose. The purpose of the study is to [briefly describe study purpose, no more than 2-3 sentences]. Procedures. If you choose to participate, you will be asked to [give brief overview of key study procedures]. Duration. It is expected that your participation will last approximately [period of time � duration, number of visits]. Risks. Some of the foreseeable risks or discomforts of your participation may include [describe the most important risks. Consider those most probable and/or highest magnitude of harm. Benefits. Some of the benefits that may be expected include [insert direct benefits, or if no direct benefit to participant state no direct benefit but the researchers hope to learn/gain xyz]. Alternatives [include only for studies involving an intervention or treatment]. As an alternative to participation, you could [note appropriate alternative procedures or courses of treatment, if any, that might be advantageous to the prospective participant.]. PURPOSE OF THE STUDY [NOTE: If the full purpose is described in the key information summary above, this section may be deleted.] The purpose of this study is [explain research questions and purpose in lay language]. You are being asked to participate because [state the main reason and list the key inclusion/exclusion criteria that may make the individual eligible/ineligible to participate]. 小蓝视频 [number] people will take part in this research. HOW LONG WILL I BE IN THIS RESEARCH STUDY? [NOTE: If duration is fully detailed in the key information summary above, you may remove this section.] Your participation will last approximately [state the total time of participation. Consider the duration of participation, frequency (if multiple study visits) and provide relevant information in hours, days, weeks, months, years, or until a certain event. Include the number of times the participant will be involved in research activities, how long each activity or session will take, etc.] WHAT WILL HAPPEN IF I TAKE PART IN THIS STUDY? [NOTE: If all procedures/activities are described in the key information summary above, you may remove this section.] If you agree to take part in this study, you will be asked to [provide a detailed description of what the participant will be asked to do in chronological order (what, when, where, how)]. [If you plan to take photographs, and/or if audio and/or video recording devices will be used, explain why the photographs and/or recordings are needed for the research. State whether they can still participate if they do not wish to be recorded or photographed.] [For projects involving the collection of sensitive information or the inclusion of questions that might be upsetting, include examples of the type of questions that will be asked and describe the sensitive topic areas that are involved.] [If applicable, include a statement about whether clinically relevant research results will be shared with the participant and under what conditions. For example: 揥e may learn information about your health as part of the research. We [will/will not] share this information with you [how/why not]擼. HOW COULD I BENEFIT FROM BEING IN THIS STUDY? [NOTE: If all benefits are disclosed in the key information summary above, you may remove this section.] The benefits of participation are [describe the probable benefits of participation in the research. Do not include compensation. If there are no direct benefits to the participant, indicate that there are none. Also describe the expected benefits to others: e.g., 揑nformation from this study may benefit other people now or in the future by厰]. WHAT RISKS MIGHT RESULT FROM BEING IN THIS STUDY? There are some risks you might experience from being in this study. They are [in simple, non-scientific language, describe any reasonably foreseeable risks or discomforts. Examples include: Emotional risks (e.g., feelings of sadness or anxiety, embarrassment, guilt) Privacy risks (e.g., disclosure of private information) Social or economic risks (e.g., social ostracizing, discrimination, effects to financial standing, employability, or insurability) Legal risks (e.g., possibility of discovering activities that may require reporting to authorities, possibility of being arrested) Physical risks (e.g., nausea, muscle aches, rashes, infection, discomforts, etc.)] HOW WILL MY PRIVACY AND CONFIDENTIALITY BE PROTECTED? We will take measures to protect your privacy. Despite taking steps to protect your privacy, we can never fully guarantee your privacy will be protected. Measures we will take include [discuss steps that you will take to protect participant privacy (e.g., conduct research in private setting and/or other space consideration, the collection of sensitive information will be limited to the minimum necessary to achieve the aims of the research, allow participant to refuse to answer any question that makes them uncomfortable, discuss security parameters of online survey platforms). Discuss any known limits to protecting privacy (e.g., group participation and knowing who other participants are, etc.).] We will take measures to protect the security of all your personal information, but we can never fully guarantee confidentiality of all study information. Measures we will take include [discuss steps that you will take to protect confidentiality (e.g., whenever feasible, identifiers will be removed from study-related information, and data with identifying information (informed consent, linking list, etc.) will be stored separately from data collected as part of the project; paper-based records will be kept in a secure location and only be accessible to personnel involved in the study, computer-based files will be encrypted and only made available to personnel involved in the study through the use of secure access privileges and passwords, prior to accessing any study-related information; audio and/or video recordings of participants will be transcribed and then destroyed to eliminate audible or visual identification of participants, etc.). Discuss any known limits to protecting confidentiality (e.g., limits of data security and storage, data collected in group settings, etc.)]. WHAT WILL HAPPEN TO THE INFORMATION WE COLLECT ABOUT YOU AFTER THE STUDY IS OVER? Information [and/or specimens] collected for this research will be used to [describe how information will be published and disseminated and whether identifiable information would be included such as the participant抯 name (e.g., 揥e may publish/present the results of this research. However, we will keep your name and other identifying information confidential� [OR] 揥ith your permission, your name will be used in [e.g., conferences, published reports] about this study.擼. We may share your research data with other investigators without asking for your consent again, but it will not contain information that could directly identify you [OR] We will not share your research data with other investigators. [If data must or will be deposited in a public or other repository, briefly describe.] HOW WILL WE COMPENSATE YOU FOR BEING PART OF THE STUDY? You will receive [nature and total amount of incentive/compensation] for your participation in this study. [Describe when and how compensation will be made. If no compensation will be offered for their participation, state so. Describe how compensation will be determined if the participant withdraws from the research before the end of the study.] WHAT OTHER CHOICES DO I HAVE IF I DON扵 TAKE PART IN THIS STUDY? [Delete this section if not applicable to the study. For projects that involve an intervention that might treat or improve a condition or a disease, describe alternatives to participation in the research study. These could include intervention or treatment available outside the research context. Sample text: 揟here may be other ways of treating your condition if you don抰 wish to be in this research. Check with your healthcare provider to discuss other options.擼 VOLUNTARY NATURE OF THE STUDY Taking part in this research study is your decision. Your participation in this study is voluntary. You do not have to take part in this study, but if you do, you can stop at any time. You have the right to choose not to participate in any study activity or completely withdraw from continued participation at any point in this study without penalty or loss of benefits to which you are otherwise entitled. Your decision whether or not to participate will not affect your relationship with the researchers or 小蓝视频. If you decide to withdraw before this study is completed, [discuss the process for participants to withdraw once the study has begun. State if participants can request their information not be used for research or if there are any limitations to requesting their information be withdrawn. If you are taking photographs or audio or video recording, address how the participant抯 recording will be destroyed. If using online surveys, offer participants an option at the end of the survey to submit their responses, and state if survey is set up such that responses are not saved to the server if a participant chooses not to submit their responses.] [Describe circumstances, if any, under which the participant抯 participation may be terminated by the PI without consent of the participant.] IF YOU ARE INJURED BY THIS RESEARCH [Delete this section if this study is not greater than minimal risk and involves no possibility of injury.] In the event that this research activity results in an injury, treatment will be available, including first aid, emergency treatment, and follow-up care as needed. Care for such injuries will be billed in the ordinary manner, to you or your insurance company. CONTACT INFORMATION FOR QUESTIONS ABOUT YOUR RIGHTS AS A RESEARCH PARTICIPANT The main researcher conducting this study is [name of PI and department, as well as class year if PI is a student] at 小蓝视频. Please ask any questions you have now. If you have questions later, you may contact [principal investigator抯 name] at [phone number] or [email address] or the faculty advisor for this study, [name of faculty advisor and department] at [phone number] or [email address]. If you have questions or concerns regarding this study and would like to speak with someone other than the researcher, you may contact the Institutional Review Board Chair, 小蓝视频, 815 N. Broadway, Saratoga Springs, NY, 12866, HYPERLINK "mailto:irb@skidmore.edu" irb@skidmore.edu. STATEMENT OF CONSENT I have had the opportunity to read and consider the information in this form. I have asked any questions necessary to make a decision about my participation. I understand that I can ask additional questions throughout my participation. I understand that by signing below, I volunteer to participate in this research. I understand that I am not waiving any legal rights. I have been provided with a copy of this consent form. I understand that if my ability to consent or assent for myself changes, either I or my legal representative may be asked to re-consent prior to my continued participation in this study. If using audio/video/photography in the research, include the following: As described above, you will be [audio/video recorded and/or photographed] while performing the activities described above. [Recordings/photographs] will be used for [data analysis only/included in conference presentations/used for educational purposes, etc.]. Initial the space below if you consent to the use of [audio/video or photographs] as described. ____ I agree to the use of [audio/video recording or photography] If requesting permission to identify an individual as having participated in the research, include the following: With your permission, your name will be used in [e.g., conferences, published reports] about this study. Initial in the space below if you consent to the use of your name as described. ____ I agree to the use of my name [and any other pieces of information] _______________________ _____________________________ _________ Name of Adult Participant Signature of Adult Participant Date PARENT OR LEGALLY AUTHORIZED REPRESENTATIVE PERMISSION [Delete this section if not applicable to the study. For more than minimal risk research involving children, signature by two parents may be required.] By signing this document, you are agreeing to [your child抯 OR the person抯 named below] participation in this study. Make sure you understand what the study is about before you sign. We will give you a copy of this document for your records. We will keep a copy with the study records. If you have any questions about the study after you sign this document, you can contact the study team using the information provided above. I understand what the study is about and my questions so far have been answered. 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