Consent Form

State the specifics and purpose of the research project.  Be sure to include any potential direct or indirect benefits for the participant.  For example:

Since you are a member of the user group we are studying, you are invited to participant in a study investigating (research title) _______________ ______________________________.  We hope to learn more about __________________________________, and your participation will be helpful in this effort.  Results of this research will be used to improve ________________________ _________________________.  This research is being conducted by (name(s)/department) _____________________________ under the direction of (name/department),_______________ ________________________________. 

Describe what will happen, including any data collection methods used (direct observation, videotaping) and the estimated time for their involvement.  For example:

            During the research project, you will be asked to__________________________________ ________________________________________________________.  Your involvement will take approximately (time minutes/hours)_________ .   

Let the participant know the research will be kept confidential in any records and reports generated from this research.   For example:

 Any comments or expressions made during your participation may be used for the purpose of evaluation and showing the results of this research; however, identities of participants will remain confidential and disclosed only with your permission.

Your decision whether or not to participate will not affect your future relations with (company name) ____________________________.  If you decide to participate, you may withdraw from the study at any time without affecting your status at (company name)______________________________.  Your signature below indicates that you have read the information provided above and have voluntarily decided to participate.  If you have any questions about this research now or during the study, I will be glad to answer them.   

Please sign both copies of this form.  Keep one and return the other to the researcher.

_________________________________               ___________________

Participant’s Signature                                                                     Date

_________________________________                ___________________

Researcher’s Signature                                                                   Date