Sample Signed Consent Form
Distribute unsigned to each subject and retain signed form for your records
Consent to Participate in a Research Study
Luxury Boxes at the Stubblefield Center
You are invited to be a part of a research study about the community’s reaction to the new luxury
boxes being built at Stubblefield Center.
This study is being conducted by John Smith of the University of Arkansas – Fort Smith Athletic
The purpose of the research is to identify issues that impact a community’s acceptance of new
athletic facilities; the results may be used to inform decision-makers at other universities
contemplating similar projects.
If you agree to be part of the research study, you will be asked to complete a survey that will take
about 5 minutes. You will be given a $5 gift card to the campus cafeteria to thank you for your
Participating in this study is completely voluntary. Even if you decide to participate now, you
may change your mind and stop at any time. You may choose not to answer questions for any
reason. If you choose not to participate, this will in no way affect your relationship with the
University of Arkansas - Fort Smith.
All responses to this survey will be kept confidential and in a locked desk and destroyed upon
completion of the study.
If you have questions about this research study, you can contact the researcher, John
Smith, University of Arkansas – Fort Smith, Department of Athletics, 1234 East Waldron Road,
Fort Smith, AR. 479-555-1234
If you experience negative feelings due to completing this survey, please contact the UAFS
Counseling Center at 479-555-1235, Pendergraft Health Sciences Center, UAFS Campus.
The University of Arkansas – Fort Smith Institutional Review Board 479-788-7855.
I agree to participate in the study.