Sample Informed Consent Form (Page 2 of 3) in pdf

Thiel College Institutional Review Board

the subject is not "signing away" any rights. Their signature merely indicates that the subject has

read the document or has had it read to him/her, has had a chance to discuss it with the

investigator, and understands it.

Information in the consent document should be presented to prospective subjects "in a language they

can understand." The reading level of the consent form should match the reading level and background

of the subjects. In some cases the document may need to be translated into another language. It is best

to use simple declarative sentences and avoid abstract, academic words and phrases. It is best to

construct the consent form using "you" rather than "I" because it may be unclear whether "I" refers to the

investigator or to the subject. Use large print and wide margins for readability. Internal subheadings will

always make the form more readable.

If the prospective subject uses a language that the investigator does not speak, it might be necessary to

have a translator present who will go over the document point-by-point with the subject. If the

prospective subject speaks English but does not read it, the investigator may be the one to go over the

document orally with the subject.

The federal regulations emphasize that an investigator should get signed consent. If a subject is a minor

(a person under age 18 in Pennsylvania, or below the age of majority in the state or country where he/she

lives), the signed consent of a parent or legal guardian is required. Ordinarily the investigator should give

one (signed) copy of the consent form for the subject to keep, and retain another (signed) copy with the

project records.

In unusual circumstances, the IRB may waive some points that are usually covered in the consent

document. In some cases the IRB may determine that your research is "exempt" under Federal

Guidelines, which may mean that you will not need to employ a consent form. But it is in your interest to

submit a consent form anyway to avoid unnecessary delays in reviewing your application.

An Informed Consent Form Example

The following template is adapted from a form posted at the website of the IRB at the University of

Minnesota. You may alter it to your own needs.

My name is (blank) and I am a student in the American Studies Program at Thiel College in Greenville,

Pennsylvania. I am doing research about rodeos in the American West. I would like to interview you. You

were selected as a possible participant because [explain how subject was identified.] We ask that you

read this form and ask any questions you may have before agreeing to be in the study.

The interview would take about half an hour of your time, and I would like to tape-record it with your

permission. You will be asked to talk about [describe some questions so that they will know generally

what they'll be doing]. Your contribution will be valuable in teaching others about life in the west today. If

you provide your address, I'll send you copies of my paper. There are no particular risks to participating in

this study as the questions are non-controversial and not personal.

I plan to use the interview information in conducting my senior research at Thiel. I will keep your identity

confidential and use a pseudonym when referring to you, unless you give explicit permission below to use

your name. We will keep all facts about you private. We will keep your records private to the extent

Sample Informed Consent Form Page 2