Lhu Irb Consent Form Template For Online Surveys printable pdf download

LHU IRB Consent Form

Template

for Online Surveys

_______________________________________________________________________________

TITLE OF STUDY

Primary Investigator (s): ____________________________________________________________

____________________________________________________________

Address

(campus address or appropriate business address)

____________________________________________________________

Phone and Email: ( ______ ) ________________________

______________________________

( ______ ) ________________________

______________________________

If there are Co-Investigators, Research Advisors, etc provide same info for them as above.

We/I invite you to participate in a study of…

[Describe the research topic and briefly state why it is a relevant topic

on which to conduct research. If there are selection criteria for the study, the following wording should also appear in the

first paragraph],

You have been selected for this study because…

Investigational Procedures

If you choose to participate in this study, you will indicate your willingness by clicking below on the link to the

online survey. The survey that you will

complete…

[Be sure to describe what the participants will be asked to do and to estimate the amount of time

required to complete the survey. It is helpful to describe the number and type of questions and to

even provide an example of the questions to be asked..]

Risks and Benefits

[Note: Research conducted online must be classified as “minimal risk,” and as such requires the following

paragraph]

This investigational procedure does not pose any more risk than you experience in normal daily living. If you

(…any potential benefits to the participant…)

participate in this study, you may experience

and the satisfaction

that comes with research and discovery. We appreciate your assistance in our research effort and hope you will

find the experience rewarding. We do not promise, however, that you will receive any of these benefits

[There

may also be benefits to persons or organizations beyond the participants; this information should also be stated here.]

Privacy of Records

[If it will be possible to trace a data record back to the participant, use the following statement.]

Any information that we learn about you that can be traced to you will be used responsibly and

will be protected against release to unauthorized persons.

Lhu Irb Consent Form Template For Online Surveys