Sample Informed Consent Forms for IRB

January 14, 2009

Read the SoTL Kit on IRB and SoTL:
Institutional Review Board (IRB) and the Scholarship of Teaching and Learning

Sherry Linkon’s INFORMED CONSENT FORM for Surveys
This is the informed consent form Sherry Linkon used with her students in her project. This is intended as a model only. Faculty wishing to create such a form should have their project and the form cleared by the appropriate authorities at their own institution.
Dear Student:

Over the past year and a half, I have been conducting research on students’ learning in courses that use interdisciplinary approaches. I plan to continue the research this term and I hope you will help. My research focuses on improving students’ understanding of interdisciplinary analysis. This term I will ask you to complete several informal tasks in class that will help me assess your learning. I will ask you to respond to several surveys, write brief reflective statements, and comment on your own learning experience in this course. If you are willing, I will save copies of your papers, which I will analyze later. Also, at some point late in the term, another faculty member will come to class to interview you as a group about your experiences in the course. By participating in this study, you will help me improve my own teaching and contribute to research that will be read and used by other faculty at YSU and around the country.

None of this research will put you at risk in any way. You may choose not to participate in the surveys and interview and not to have your papers included in the study. Your decision about whether to participate will have no bearing on your course grade. When I use data gathered from this study, I will not identify you individually.

If you have any questions about this research, feel free to ask. If you are willing to participate, please sign below.

Sincerely,
Sherry Lee Linkon

I agree to participate in this semester’s study of student learning. I understand that I may choose at any time not to complete a survey or participate in an interview. I will be given the opportunity to have my written work excluded from the study. My identity will be protected, and my course grade will in no way be affected by my participation or non-participation in this project. I am over 18.

Student signature, date

_______________________________________________

Betsi Stephen’s INFORMED CONSENT FORM for Videotaping
This is intended as a model only. Faculty wishing to create such a form should have their project and the form cleared by the appropriate authorities at their own institution.

(Model Consent Form)

Journeys Far From Home

Fall 2001

Visible Knowledge Project

If you are interested in participating in Professor Stephen’s research project, “Understanding the Social Context of Immigration through Film and Text”, then please initial that you have read about the Visible Knowledge Project and heard the description of the specific research project. Then sign your name in the blank space if you are willing to participate in the group session and/or the individual session. Please be aware that all sessions will be videotaped and will be in the archives of the Center for New Designs for Learning and Scholarship at Georgetown University. Students must be at least 18 years of age to participate in the research project.
_______(initials) I am at least 18 years old. I have read the description of the Visible Knowledge Project and have heard Professor Stephen’s proposal of her research project.
I, _____________________________, am willing to participate in small group projects that will be videotaped. In the taped sessions, students will view a film clip, then be asked questions related to that film clip.
I, __________________________, am willing to participate in an individual interview with Professor Stephen that is videotaped in which we discuss the role of film in this course.
I, __________________________, have read and signed the appearance release.
Dated: ____________________

_______________________________________________

Melinda L. de Jesús’ INFORMED CONSENT FORM for Videotaping
This is intended as a model only. Faculty wishing to create such a form should have their project and the form cleared by the appropriate authorities at their own institution.
Dear ___________________________________:

I am a professor of Asian Pacific American Studies at Arizona State University. I am conducting research to study the efficacy of new media-based pedagogies in the Asian Pacific American Studies classroom and how it might correlate with student ethnic identity.

I am requesting your participation, which will involve a 20 minute videotaped interview. The videotapes will be kept indefinitely for archival purposes.

Your participation in this study is voluntary. If you choose not to participate or to withdraw from the study at any time, there will be no penalty, and it will not affect your grade. The results of the research study may be published, but your full name will not be used without your permission.

Although there may be no direct benefit to you, the possible benefit of your participation will be that your input will help me continue to develop sound new media pedagogies for future APA 310 students.

If you have any questions concerning the research study, please call me at (480) 727-7340.

Sincerely,

Dr. Melinda L. de Jesús

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