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 Outline on Consent & Confidentiality in Social Research
External
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  -  Research Design
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  -  Research Instruments
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  -  HIC Sample Consent Form
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  -  Sample:  Informed Consent Document for an Anonymous Survey 
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  -  Surveys 
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  Voluntary consent
 
  I understand that I am participating in this research voluntarily.
 
  I have the right to refuse participation at any time.
 
  Confidentiality Statements may include the following
 
  I understand that any information regarding my identity obtained
    in connection with this research will remain confidential.
 
  I will not write my name or otherwise indicate my identity on
    any part of this research.
 
  Authorization Statements may include the following
 
  In giving my consent by signing this form, I agree that the methods, inconveniences, risks, and benefits have been explained to me and my questions have been answered.   
  I understand that I may ask questions at amy time and that I am free to withdraw from the study at any time without causing bad feelings.
 
  My participation in this research may be ended by the investigator or by the sponsor for reasons that would be explained.
 
  Any information developed during the course of this study which may effect my willingness to continue in the research will be given to me as it becomes available.
 
  I understand that this consent from will be filed in an area designated by the Human Subjects Committee with access restricted to the principle investigator ###### or authorized representative of the Department.
 
  Introductory Statement
 
  Before any survey, interview or other Research Instrument can be administered,
     & before the Confidentiality Statement is presented for assent,
     an Introductory Statement must be given to the potential Subject		  
  Intro letter should pt to the imp of the research 
     & appeal should appeal to respondents' altruism
 
  Such an appeal is more effective than implying that the respondent
    has something to gain by answering the questionnaire
 
  Inclusion of a "reward" --a pen or small amount of money improves 
    rate of response more because it is a token of researcher's 
    appreciation than because of its intrinsic value
 

 
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SAMPLE INFORMED CONSENT FORM

Principal Investigator:                                              Phone: 
Faculty Supervisor:      Dr. Patrick Withen               Phone:  276-376-4526
Human Investigations Commitee Chair:  Dr. Jim Horton       Phone:  276-555-5555
Department of  Social Sciences, UVaWise, 1 College Ave., Wise, VA, 24293
Project Title:
Expected Duration:  This survey should take              to complete.

Purpose and Background:   You are invited to participate in a study of (state what is being studied).  I, Sample Student, am conducting this research because of my interest in this area, and as part of my Senior Capstone Porject in Sociology, which is a requirement for graduation from UVaWise.  I am examining (state what the study is designed to discover or establish.  Insert an santized version of your thesis statement here.).  You were selected as a possible participant in this study because (state why and how the subject was selected
Procedures:   If you decide to participate, I (your name) will (describe the procedures to be followed, including their purpose, how long they will take, and their frequency.)
Risks/Discomforts:   There are no measurable potential risks or discomforts involved in this survey other than anxiety caused by the survey questions. 
(Describe the discomforts and inconveniences reasonably to be expected as well as an estimate of the total time required.  Describe the risks reasonably to be expected.  Any standard treatment that is being withheld must be disclosed.)
Benefits:   There may be no direct benefit to you from participating in this study.  However, the information that I provide may help health professionals better understand how (what you expect to learn from your study.)  (Describe appropriate alternative procedures that might be advantageous to the subject, if any.)
Confidentiality:   Any information that is obtained in connection with this study and that can be identified with you will remain confidential and will be disclosed only with your permission.  (If you will be releasing information to anyone for any reason, you must state the persons or agencies to whom the information will be furnished and the nature of the information to be purposed, and the purpose of the disclosure.)
Costs:  (If there is a possibility of additional costs to the subject because of participation, describe it.) 
Payment:  (If the subject will receive compensation or any other benefit, describe the amount or nature.)
Consent:   Your decision whether or not to participate will not affect your future relationships with (institution or agency).  If you decide to participate, you are free to discontinue participation at any time without affecting (your treatment, your care, your activities, your relationship).
 Questions:   If you have questions, please ask us.  If you have any additional questions later, (investigator’s name) will be happy to answer them.  If for some reason you do not wish to do this, you may contact the Chair of the HIC Kathleen Huttlinger, Smiddy Hall, room 243.
You will be offered a copy of this form to keep.
PARTICIPATION IN RESEARCH IS VOLUNTARY.  You are free to decline to be in this study, or to withdraw from it at any point.  Your decision as to whether or not to participate in this study will have no influence on your present or future status as a (patient, student, employee).
You are making a decision whether or not to participate.  Your signature indicates that you have read the information provided above and have decided to participate.  You may withdraw at any time after signing this form should you choose to discontinue participation in this study.

_____________________________________________________________________
Signature         Date

____________________________________________________________________
(Signature of Parent or Legal Guardian)     Date
(This line should not appear on forms that will be given to subjects consenting for themselves.)

___________________________________________________________________
Signature of Witness (when appropriate)    Date

___________________________________________________________________
Signature of Investigator       Date

The End