| The following
information describes the research study in which you are being asked to
participate. Please read
the information carefully. At
the end, you will be asked to sign if you agree to participate.
Investigator
Dr. Jane Doe, an
associate professor in the psychology department at UNCA, will conduct
this research project. Dr.
Doe is being assisted in this research by Ms. Joan Day, a recent
graduate of UNCA who is currently a graduate student in clinical
psychology at Western Carolina University.
Purpose
of Study
The purpose of this
research study is to better understand how women cope with traumatic
life events experienced in childhood.
What
Will Happen During This Study
- You
have been asked to participate in this study because of your
responses to a questionnaire that you completed during the
orientation for new students held this past August.
At that time, you identified yourself on your questionnaire
as someone who would be willing to participate in a follow-up
interview.
- You
will be interviewed by Dr. Doe or Ms. Day for approximately one
hour. The interview
will consist of questions about your adjustment to college,
influences on your adjustment to college, stressful life events you
have experienced in the past, the impact of such stressful events,
and the ways in which you have coped with these events.
- The
interview will be audiotape-recorded.
The audiotapes will be transcribed by Dr. Doe or Ms. Day.
Possible
Risks or Discomforts
It is possible that
talking about stressful life events you have experienced in the past
could make you personally uncomfortable.
You are welcome to skip any questions that make you
uncomfortable, and you are also welcome to stop the interview at any
time.
Possible
Benefits
Some people find
talking about stressful life events from the past to be helpful.
Another possible benefit of this study is that the results may
help other people who have experienced stressful life events learn about
effective ways of coping.
Privacy
We will make every
effort to protect your privacy. Your
responses to the interview questions will be kept strictly confidential.
The audiotape recording of your interview will be coded by a
number rather than your name, and after the audiotape is transcribed, it
will be destroyed. The
transcriptions will contain no identifying information.
When the results of this study are published, participants will
be referred to by code numbers, not names.
Once the study is completed, any records containing the names of
interview participants will be destroyed.
Your
Rights
The decision to
participate in this study is completely up to you. You will not be treated any differently if you decide not to
be in this study. If you
decide to be in the study, you have the right to stop being in the study
at any time.
Contact
Information
Dr. Jane Doe
(828/251-1234, jdoe@unca.edu) will gladly answer any questions you may
have concerning the purpose, procedures, and outcome of this project.
You may also contact the Chair of UNCA's Institutional Review
Board (IRB), Dr. Don
Diefenbach (828/251-6731, ddeifenb@unca.edu) to discuss any questions or
concerns you may have about the rights of study participants. (The IRB
is a college committee concerned with the protection of human subjects
in research.)
SUMMARY
I have read the
information in this consent form and agree to participate in this study.
I have had the chance to ask any questions I have about this
study, and they have been answered for me.
Although
the investigator will make every effort to maintain confidentiality, I
understand that research records must be made available to UNCA's IRB,
if they are requested. I will receive a copy of this form after it has been
read and signed.
| _____________________________
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__________________________
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| Printed Name
of Participant
|
Signature of
Participant |
Date |
| ___________________________________________________________________________ |
| Signature of
Person Obtaining Consent
Date |
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