Sample Informed Consent Form (HERB)

Informed Consent Form

The Department of Psychology at Wagner College supports the practice of protection of human participants in research.  The following will provide you with information about the experiment that will help you in deciding whether or not you wish to participate.  If you agree to participate, please be aware that you are free to withdraw at any point throughout the duration of the experiment without any penalty [Note: the penalty statement is only appropriate for students].

In this study we will ask you to __________________*.  If you have any [insert reason why they should not participate if applicable], please inform the experimenter and the study will end now.  All information you provide will remain confidential and will not be associated with your name.  If for any reason during this study you do not feel comfortable, you may leave the laboratory and receive credit for the time you participated and your information will be discarded.  Your participation in this study will require approximately _____ minutes.  When this study is complete you will be provided with the results of the experiment if you request them, and you will be free to ask any questions.  If you have any further questions concerning this study please feel free to contact us through phone or email: RESEARCHER NAME at (718-) or SUPERVISOR NAME at (718-).  Please indicate with your signature on the space below that you understand your rights and agree to participate in the experiment.

Your participation is solicited, yet strictly voluntary.  All information will be kept confidential and your name will not be associated with any research findings. 
______________________________                                    _______________________________
            Signature of Participant                                                 NAME, Investigator

                    Print Name
PLEASE NOTE: If your participants cannot legally give consent (those under 18, for example), the form must be addressed to the parent or guardian.

*If you are asking the participant to read something, view something, reveal personal information, eat something, taste/smell something, you must inform them.  You must warn participants if it is possible something you ask them to read or view may be offensive or explicit.  Please describe how long (approximately) the procedure will take.   Potential participants must be able to make an informed consent to participate!

**If your consent form is more than one page long, be sure to number the pages in the manner shown below with a space for the participant to initial each page (so they it can be confirmed that they read each page).
example: "page 1 of 4 _____" for the first page of a four-page form.