Sample Informed Consent Letter Template

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SAMPLE INFORMED CONSENT LETTER
STUDY OF THE UNIVERSITY OF MASSACHUSETTS AMHERST
FACULTY'S KNOWLEDGE OF DISABILITIES,
EXPERIENCE WITH EDUCATING STUDENTS WITH DISABILITIES,
AND ATTITUDES THAT FACULTY POSSESS TOWARDS
STUDENTS WITH DISABILITIES
CONSENT FOR VOLUNTARY PARTICIPATION
I volunteer to participate in this qualitative study and understand that:
1.
I will be interviewed by using a guided interview format consisting of seven questions.
2.
The questions I will be answering address my views on issues related to disability
awareness training for faculty of my college or school at the University of Massachusetts
Amherst. I understand that the primary purpose of this research is to identify activities
that will effectively increase faculty awareness of disability.
3.
The interview will be tape recorded to facilitate analysis of the data.
4.
My name will not be used, nor will I be identified personally, in any way or at any time. I
understand it will be necessary to identify participants in the study by position and
college affiliation (e.g., a Department Head from the College of Engineering said . . . .).
5.
I may withdraw from part or all of this study at any time.
6.
I have the right to review material prior to the oral exam or other publication.
7.
I understand that results from this survey may be included in [researcher's name]’s
doctoral dissertation and may also be included in manuscripts submitted to professional
journals for publication.
8.
I am free to participate or not to participate without prejudice.
9.
Because of the small number of participants, approximately twelve, I understand that
there is some risk that I may be identified as a participant of this study.
If you have questions or comments regarding this study, please feel free to contact
[researcher's name]. [Researcher's name]’s phone number is [researcher's phone number] and
email address is [researcher's email address]. You may also contact [researcher's name]’s
chairperson, [chairperson's name], at [chairperson's phone number] or [chairperson's email
address] or the Associate Dean for Academic Affairs, Dr. Linda Griffin, lgriffin@educ.umass.edu
Researcher’s Signature
Date
Participant’s Signature
Date

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