Fillable Instructions for Researchers: The bolded headings must be (Broward College)

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Instructions for Researchers: The bolded headings must be (Broward College)

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INFORMED CONSENT FORM
PURPOSE OF THE STUDY
You are invited to be a participant in a research study about
You were selected as a possible participant because
We ask that you read this document carefully and ask any questions you may have before agreeing
to be in the study. The purpose of this study is
DURATION OF THE STUDY
Your participation will require
PROCEDURES
If you agree to be in this study, we will ask you to do the following things:
RISKS/BENEFITS
The following risks may be associated with your participation in this study:
The following benefits may be associated with your participation in this study:
Instructions for Researchers: The bolded headings must be included in your consent form. The text below is
suggested language. Insert study specific information using the guidelines from the bracketed information.
Remember to keep the language simple and your explanations concise. Please note that this is only a
template/guide. Create your final document in Microsoft Word.
Insert Study Title
Insert general statement about study.
Explain how participant was identified.
Explain research questions and purpose in lay language.
Indicate the amount of time in minutes, hours, days, weeks, etc., that participants can be expected to be in
the study.
Explain tasks and procedures from the participant’s point of view. What will s/he be expected to do? Be
sure to explain how groups will be assigned (if applicable) and if any of the procedures are experimental.
Honestly explain risks, hazards, or discomforts, including the likelihood of any identified risks. List any
physical, psychological, societal, or economical risks associated with participation.
Describe any benefits to the participant or others that could be reasonably expected from the research.
Benefits to the participant and/or society must be stated.
CONFIDENTIALITY
The records of this study will be kept private.
In any report that is published or presented, we will not include any information that will make it
possible to identify a participant. Research records will be retained for a period of at least 36
months after study completion.
RIGHT TO DECLINE OR WITHDRAW
Your participation in this study is voluntary. You are free to participate in the study or withdraw
your consent at any time during the study. Your decision whether or not to participate will not
affect your current or future relations with Broward College or any of its representatives. If you
decide to participate in this study, you are free to withdraw from the study at any time without
any consequences or affecting those relationships.
CONTACT INFORMATION
The researcher(s) conducting this study is(are):
You may ask any questions you have right now. If you have questions later, you may contact the
researchers at:
If you have questions or concerns regarding this study and your rights as a research participant,
you may contact Dr. Luis Pentzke, Institutional Review Board Administrator/Chair, Broward
College, phone 954-201-2292, e-mail lpentzke@broward.edu.
STATEMENT OF CONSENT
I was given a chance to ask questions about this study and they have been answered. I have read
the information in this consent form and by signing below, I certify that I am at least 18 years of
age and agree to participate in this study.
You will be given a copy of this form to keep for you records.
_______________________________
Signature of
Participant
________________________________
Printed Name of Participant
________________________________
Signature of Person Obtaining Consent
__________________
Date
__________________
Date
__________________
Date
Describe how records will be stored and who will have access to study records.
Include phone number, email address.
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Instructions for Researchers: The bolded headings must be (Broward College)

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Completed 18 August 2020

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