University of Pittsburgh 2117 Cathedral of Learning
School of Social Work Pittsburgh, PA 15260
(Research assistant name here)
(Project title, and funding source)
In consideration of my participation on the research project (the Project) in the School of
Social Work, in a capacity in which I may receive confidential information on which the success of the
project depends, I acknowledge and agree that:
Any information or materials related to the Project received by me while participating in the
Project, during any class-related or research-related activity, shall be kept strictly confidential. I will not
disclose to any person, either during or subsequent to, my participation, any confidential Project, class, or
participant-related information, including the names of participants, or any findings.
I will not permit any person to examine or make copies of any reports, memoranda, or other
documents related to the Project, without the express permission of the faculty investigator.
Upon completion of my participation on the Project, I will deliver to the faculty investigator any
records or material of any nature whatsoever related to the Project, including all copies thereof.
The above understanding shall survive the termination or cancellation of employment or service
I acknowledge the disclosure of confidential Project information would be in derogation of the
obligations I have undertaken and may give rise to irreparable injury to the faculty investigator or to
project participants, inadequately compensable in damages, and that other affected parties may seek
and obtain injunctive relief against the breach or threatened breach of the above-listed
misunderstandings, in addition to any other legal remedies which may be available.
This Agreement shall be binding upon my heirs, legal representatives, and assigns.
Signed this ______________day of _______________________, 20_____.
(Type or print name)