Example of Consent Forms

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					                                    Model Consent Forms

There are 3 sample consent forms below to give an idea of how to obtain informed consent from
research participants. The more risk involved in project, the more needs to be stated on the
consent form. As most research we do does not involve risk to participants, these provide the
basic, minimal statements that inform the participant of the nature of the study, their rights to not
participate or withdraw their data, and costs and benefits, if any, of the participation.



1. For an Experiment

Grinnell College                                      Janet M. Gibson
Dept. of Psychology                                          Fall 2000

                                Cognitive Psychology Experiment
                                         Consent Form

In this study you will complete a variety of paper and pencil tasks which involve rating words
and creating words. There are no risks involved, and you may stop participating at any time
without penalty. Your data remain anonymous and confidential. When the tasks are done, you
will receive a "debrief form" which will describe the reasons we are collecting data on these
tasks. The experiment takes just under a half hour. General psychology students receive 1 extra
credit point.

If you agree to participate in this experiment, please sign below:

Printed Name                  Written Name        Date
1. ___________________        ___________________ ___________________

2. ____________________ ___________________ ___________________

3. ____________________ ___________________ ___________________
2. For a survey study

Grinnell College                                     Janet M. Gibson
Dept. of Psychology                                         Fall 2000

                                Cognitive Psychology Experiment
                                         Consent Form

In this study you will complete a questionnaire concerning the strategies you use for studying for
an exam in a science course. There are 20 questions, and we estimate it will take about a half
hour to complete. Some demographic information is collected as well. You are free to not answer
any question, to stop participating at any time without penalty, and to not have this survey be
part of the data set. All questionnaires are anonymous, and the forms will be kept confidential by
the researcher. The information you provide will help further our research in issues in science
education. If you have any questions, please ask Janet Gibson (gibsonj, x3168). [if a web survey:
Completing this survey acts as your consent to participate in this study] [if paper survey, please
sign below to indicate you have read this paragraph and agree to participate in our study.] Thank
you.



3. For nonwritten consent

My name is Janet Gibson, and I am a professor at Grinnell College. I am doing a research project
on people's perception of memory loss (if any) as they age. I would like to ask you a set of
questions that concern your perceptions of forgetting for everyday things, like appointments,
names, things to do, or where you have placed things. There are no risks involved, and you are
free not to answer any question if you don't want to. At any time if you want to stop that is fine,
and at the end if you would rather I not include your answers in my study, that is fine. Your
answers are anonymous and confidential. I'll also ask if you have questions to ask me, and when
the project is finished I will be happy to send you a summary of my findings from this survey. I
will tell you that I am not able to diagnose memory problems or evaluate your psychological
health. You don't need to have a very good memory or a very poor memory to participate; I hope
to collect a random sample of people and expect to talk with people with all kinds of memories.
After I talk to about 30 people, I will organize the answers and write a paper that I hope will
contribute to our knowledge about the kinds of things people perceive are more forgettable than
in their past or whether any changes at all seem noticeable as we age. These questions will take
about 10 minutes. Are you interested in taking some time and answering these questions for my
study? (now or set up a time). Do you have any questions you want to ask about participating
before we start?