ups or presentations, and they must be told if those quotations will contain any information
that allows participants to be identified.
5. COMPENSATION (if applicable)
“For participating in this study you will receive _____________________. If you withdraw from
the study prior to its completion, you will receive ______________________.”
6 & 7. CONTACT INFORMATION
“If you have questions at any time about the study or the procedures, [or you experience
adverse effects as a result of participating in this study *if applicable to your project] you
may contact the researcher, [name], at [email address], and [phone number]. This project
has been reviewed and approved by the REB/Community Research Ethics Board. If you
feel you have not been treated according to the descriptions in this form, or your rights as a
participant in research have been violated during the course of this project, you may
contact Name/Chair, REB/Community Research Ethics Board, insitutition/Community
Research Ethics Office, (xxx) xxx-xxxx.”
8, 11, & 16. PARTICIPATION
“Your participation in this study is voluntary; you may decline to participate without
penalty. If you decide to participate, you may withdraw from the study at any time without
penalty and without loss of benefits to which you are otherwise entitled. If you withdraw
from the study, every attempt will be made to remove your data from the study, and have it
destroyed. You have the right to omit any question(s)/procedure(s) you choose.”
9. FEEDBACK AND PUBLICATION
Describe how the results of the research will be disseminated: books, journal articles,
presentations, etc. Indicate how participants may obtain information about the results of
the research; indicate an approximate date when feedback will be available.
10. CONSENT
“I have read and understand the above information. I have received a copy of this form. I
agree to participate in this study.”
Participant's printed name & signature _________________________________ Date ___________
Parent/Guardian printed name & signature (*if applicable)___________ Date ___________
Researcher printed name & signature ___________________________________ Date ___________
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