Lhu Irb Consent Form Template For Online Surveys (Page 2 of 2) in pdf

[If there will be no way to trace a data record back to the participant, as with an anonymous survey, use the

Your data record is totally anonymous. All the information you provide will be

following statement.]

used responsibly and will be protected against release to unauthorized persons.

Your data record will likely be viewed by members of the investigation team listed on this form as

[Followed by]

(state who all that would be – e.g., professors of a specific class in which the research is

well as

conducted). By

clicking on the survey link below and by submitting a completed survey, you are giving permission to use your

data record in this study. The results of this study may be published in the

(state the one that applies only if

publication is possible or probable -- professional, medical, educational)

literature or it may be presented

(state

where – e.g., professional conference, to the students of Dr. Offutt’s PSYC308

class), but no publication or

presentation will contain information that will identify you.

Payment

You will receive no payment or compensation of any kind for participating in this study.

[It is very difficult to

compensate your participants for completing an online survey without asking them to identify themselves. If there is a way to do this

while ensuring anonymity, explain the compensation.]

Conclusion

Your decision whether or not to participate in this

[If participants are students, faculty, and staff at LHU]

study is voluntary and will not affect your standing at Lock Haven University of Pennsylvania.

Your decision to participate in the study is

OR [For participants recruited from outside the University]

voluntary.

Even if you decide to participate now, you may stop at any time and close your

[Followed by]

browser. You are making a decision whether or not you will participate in this study. If you click

on the link below and submit a completed survey, you are indicating your agreement to

participate based on reading and understanding this form. If you have any questions, please

contact an investigator identified at the top of this form prior to completing the survey.

If you have any questions regarding your rights as a research participant, please contact Dr. Beth McMahon,

Chairperson, Lock Haven University Institutional Review Board for the Protection of Human Subjects (IRB-

PHS) at

bmcmahon@lhup.edu

or 484-2214.

(insert “button” that says something like

Based on the information above, I agree to participate in this study.

“continue to survey”)

If you do not wish to participate in this study, please

[delete this email or close the browser, which ever is

relevant]

NOTE: In your final “consent” statement, all text in red should be deleted or altered to fit your study. The

entire document should be in black be absent of any and all instructional statements from this template.

Lhu Irb Consent Form Template For Online Surveys Page 2

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