Irb Approval Form (Page 3 of 3) in pdf

Irb Approval Form Page 3

Who can you contact if you have questions about your rights as a participant?

Use the following language::

You can speak to the researcher or you can contact the Our Lady of the Lake Institutional Review Board

at 434-6711, ext. 2489 or grahl@lake.ollusa.edu.

Documentation of Informed Consent

Use the following language:

Your signature on this form indicates that you understand the information provided to you about

participation in this research study and that you freely agree to participate. You will be given a signed

copy of this consent form to keep, and the researcher will also keep a signed copy.

_____________________________________

Participant’s Printed Name

_____________________________________

_______________

Participant’s Signature

Date

_____________________________________

Researcher’s Printed Name

_____________________________________

_______________

Researcher’s Signature

Date

IRB Approval Notice

Use the following language:

This research study has been reviewed and approved by the OLLU Institutional Review Board. For

questions about participant’s rights during or after the study, contact the Chair of the IRB at 210-434-

6711, ext. 2489 or grahl@lake.ollusa.edu.

Irb Approval Form Page 3