by Dr. Cara Zaskow
Informed consent should address the following issues:
My name is _______ and I am a Psychology student at Capilano University. I am doing a study about ______________ as a course assignment. If you agree to participate, it would involve __________________ (e.g. filling out a questionnaire, etc.) that would take about ____ minutes of your time. There are no risks associated with the study. You are under no requirement to participate in this study and should feel free to decline. Even if you decide to participate, you may withdraw from the study at any time. You will not be penalized for not participating or for withdrawing. No information that identifies you personally will be collected. Your participation will be anonymous and all information will be kept confidential. The _____ (scores or questionnaires, etc.) will be shredded by the instructor at the end of the study to ensure the confidentiality of your responses. If you have any questions or concerns about the study, please contact the course instructor, Dr. ________________, email address: ________________. If you are interested in the findings of this study, please feel free to _____________ (e.g. attend the poster/power point presentation or contact the researcher).
I agree to take part in this study, which has been explained to me. I have been given an opportunity to ask questions about the study. I understand that any questions I answer will be anonymous, and that my identity will not be disclosed at any point. I also understand that my participation is completely voluntary, and I may withdraw from the study at any time. I am 18 years old or over, and am legally able to provide consent.__________________________ _________________ signature of participant & date
Capilano University | 2055 Purcell Way, North Vancouver, British Columbia Canada V7J 3H5 Tel: 604.986.1911
Sunshine Coast | 5627 Inlet Avenue, Sechelt, British Columbia Canada V0N 3A0 Tel: 604.885.9310
Capilano University is named after Chief Joe Capilano, an important leader of the Squamish (Sḵwx̱wú7mesh) Nation of the Coast Salish people. We respectfully acknowledge that our campuses are located on the territories of the Lil’wat, Musqueam, Sechelt (shíshálh), Squamish and Tsleil-Waututh Nations.