ࡱ > > C 3 4 5 6 7 8 9 : ; < = a bjbj
4( hGbhGb ( ( ( ( , T ( H f p a a a $ d" b a a
`ԁKX . 0 H " G " " a > , $ a a a 1 a a a H " a a a a a a a a a B :
Institutional Review Board
Adult Research Consent Form
Instructions to PI: Please replace red placeholder text / instructions after following and before submission.
DATE: Insert planned date of study commencement here.
PROJECT TITLE: Insert title here (must match title on approved IRB proposal).
PRIMARY INVESTIGATOR(S) AND CO-INVESTIGATORS: Insert PI and Co-investigator names, email addresses, and office phone numbers.
PURPOSE OF THE STUDY: Insert explanation of why the study is being conducted here.
DESCRIPTION OF STUDY PROCEDURES: Insert description of procedures here, using special care to ensure it is understandable to all readers.
DURATION/TIME ASSOCIATED WITH YOUR INVOLVEMENT: Insert description here.
POTENTIAL RISKS OR DISCOMFORTS: Insert description of physical, legal, economic, psychological, and other risks or discomforts possible with respect to participation in this study.
POTENTIAL BENEFITS: Insert description of non-financial benefits to participation here.
PROJECT ALTERNATIVES TO PARTICIPATION IN THE STUDY: Insert description here.
CONFIDENTIALITY OF DATA: Insert description here.
COSTS AND/OR COMPENSATION FOR PARTICIPATION: Insert description here.
CIRCUMSTANCES FOR DISMISSAL FROM THE STUDY: Insert description here.
COMPENSATION FOR INJURY: Insert description here.
CONTACT PERSONS: For more information concerning this research, please contact PRINCIPAL INVESTIGATOR at OFFICE TELEPHONE NUMBER. If you believe that you may have suffered a research related injury, contact PRINCIPAL INVESTIGATOR at OFFICE TELEPHONE NUMBER. If you have further questions about your rights as a research subject, you may contact:
IRB Chairperson
The University of Findlay
Findlay, OH 45840
419 434-4640 HYPERLINK "mailto:irb@findlay.edu" irb@findlay.edu
VOLUNTARY PARTICIPATION: Participation in this study is voluntary. You are free to participate or to withdraw at any time, for whatever reason. In the event that you do withdraw from this study, the information you have already provided will be kept in a confidential manner.
Note to investigators, please include if applicable:
For medical studies, state that the subject does not risk loss of present or future care they would otherwise receive.
For studies with students, state that the subject does not jeopardize grades nor risk loss of present or future faculty/school/university relationships.
NEW FINDINGS: You will be notified of any new information that may change your decision to be included in this study, should any new information become available.
CONSENT: Federal regulations require precautionary measures to be taken to insure the protection of human subjects on physical, psychological, social, and other issues. This includes the use of informed consent procedures. Please read carefully.
I, _________________________________ (PRINTED NAME OF SUBJECT) have been adequately informed regarding the risks and benefits of participating in this study. My signature also indicates that I can change my mind and withdraw my consent to participate at any time without penalty by contacting the study contact person designated above. Any and all questions I had about my participation in this study have been fully answered.
SUBJECT SIGNATURE:___________________________________________________
DATE
I have witnessed the consent process and believe the subject has been fully informed, understands the research study, and has agreed to participate in the study.
WITNESS PRINTED NAME:_______________________________________________
WITNESS SIGNATURE:__________________________________________________
DATE
YOU WILL BE GIVEN A SIGNED COPY OF THIS FORM TO KEEP.
( ) 8 D E F G Z n z ~ ʺ||oaoTL hh h5% 5hh hj 5B*ph hh hr 56B*ph hh hr 5B*ph hR4 h5% 5hl hl hF8 56B*ph hiyF 56B*ph hF8 56B*ph hl hl 56B*ph hF8 hl 56>*B*ph h5% *hj h5% 5 *hj hj 5 h#] h5% 5 h5% 5 j hLW h+~ UmH nH u ) F G ; <
@ A s t gd,v gdh gd5% $a$gd5% # $ , 1 : ; = h i j
.
/
0
7
G
U
دЪЪ{{vi hh hh 5B*ph hh 5hh hSS 5h3 h5% 5B*ph hh hQ 5B*ph hh h3 5B*ph h3 5h8 h5% 57 hh hN 5B*ph hN 5 h5% 5hR4 h5% 5hh h5% 5hh hj 5B*ph hh hr 5B*ph hj 5 )
% & ' ? @ A X Y Z s u
3
4
5
C
D
þììÔìÔÐ hh hHG 5B*ph h5% h,v h,v B*ph hh h,v 5B*ph h,v 5hh hiO 5B*ph hiO 5hR4 h5% 5hh h5% 5B*ph hh hr 5B*ph hh h5% 5hh hr 5 hr 5 h5% 5 /
3
4
1 2 g x y
&d P gd5% gd gd,v gd5%
6 / 0 Q Z 2 e f g x ǼΝΆvhZRhh h5% 5hh h5% 56B*ph hh hiyF 56B*ph hh h5% 56>*B*ph *h1Y h5% >* h5% 5hR4 h5% 5h htc htc 0J htc htc j htc htc Uh^ htc h htc h5% h5% hl h5% hh h5% 5B*ph hh hHG 5B*ph hh hh 5B*ph x y % & 0 1 h k u ] ^ _ hwy hiyF h5% 5B*ph *hiyF h3t? 5B*ph hiyF hiyF h5% 5\ hR4 h5% h htc h *hj hj hj *h| h5% 5hR4 h5% 5h3t? hh h5% hh h3t? hh h3t? 5h5% N ] ^ _ ^gd5% gdiyF gdiyF gd5% 2 1h:piyF / =!"#$F% D d
A T ? A c a d e m i c L o g o ( P r i n t ) _ S m a l l P r i m a r y _ B l a c k P i c t u r e 3 C : \ U s e r s \ r i f f l e \ A p p D a t a \ L o c a l \ M i c r o s o f t \ W i n d o w s \ T e m p o r a r y I n t e r n e t F i l e s \ C o n t e n t . W o r d \ A c a d e m i c L o g o ( P r i n t ) _ S m a l l P r i m a r y _ B l a c k . j p g " R G+d3~Z? D F G+d3~Z? ,Photoshop 3.0 8BIM , , 8ghttp://ns.adobe.com/xap/1.0/
image/jpeg
Academic Logo Assets
2016-01-12T11:44:31-05:00
2016-01-12T16:44:41Z
2016-01-12T11:44:31-05:00
Adobe Illustrator CC 2015 (Macintosh)
256
96
JPEG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.iid:b92724ed-c10c-4b8f-abc9-60441036c806
xmp.did:b92724ed-c10c-4b8f-abc9-60441036c806
uuid:5D20892493BFDB11914A8590D31508C8
proof:pdf
uuid:900c3375-2729-6d45-b395-47ee6a9e24ad
xmp.did:4c125e08-8ff0-46d2-a579-9bffb1570fe9
uuid:5D20892493BFDB11914A8590D31508C8
proof:pdf
saved
xmp.iid:33760cb4-69c3-451b-8827-baab3972a341
2015-12-01T11:44:55-05:00
Adobe Illustrator CC 2015 (Macintosh)
/
saved
xmp.iid:b92724ed-c10c-4b8f-abc9-60441036c806
2016-01-12T11:44:31-05:00
Adobe Illustrator CC 2015 (Macintosh)
/
Print
Adobe PDF library 15.00
}ICC_PROFILE pADBE prtrCMYKLab ) 5acspAPPL ADBE -ADBE
desc tcprt p +wtpt A2B0 A2B2 A2B1 B2A0 E 8B2A1 ~t 8B2A2 ( 8gamt desc U.S. Web Coated (SWOP) v2 text Copyright 2000 Adobe Systems, Inc. XYZ Z g 0mft2 $i
6
1^2Wy%Y !"#%#&D'f()*+-.(/H0i123457859Q:m;<=>?AB)CBD\EuFGHIJLM,NCOYPoQRSTUVX
Y#Z:[Q\f]x^_`abcdfgh#i3jBkRl^mgnqozpqrstuvwxyz{|}~ˀɁǂŃ{pdXL@3&֜ȝ|jWE3 תū}kYG6$ ڷȸ~kYG5"ŵƣǑ~lYD.оѧҐyaI1 ڲۘ}bG,{W3qHvU3sIa)\Z ,
!"#$%&'()*+,-./0123456789:;~<|=|>|?}@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`ac deefghijklmnopqrstuvwxyz{|z}o~dXMA5)ۈʉq`N=,
ٖɗmZH6%ؤʥwog`ZTOLIFEDEFHJNRW]cjr{ĄŊƐǖȝɥʭ˶̿*7DQ^kyކߔ ,8CNYcjnoldVD/ h 2
Rer
xzzzyuph^RE7)4=@?:4 ,!#"#$$%&'()*+,-./|0p1d2Y3M4A566+7!89: :;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{||}v~oiaZQH>5+!؎͏Ðxpjc^YURPOOPRUY_fnx̰߱ 8Ql»!Ceª9^ɂʦ2TtҔӲ6Lat݇ޘߧoX\[VL=*b/fMq T
p_L7! }tfUA, !"#$%z&d'N(9)%**+,-./01y2g3U4D526"7889:;<=>?@}AoBbCUDIE~%
ہrW; ϊ}bG-ޒēx`G/Ԝq_O?0"۬խЮ˯ǰı²µŶȷӹۺ 0@RfzƏǦȾ*GcЀџҿ'LsٛFsM6+1MZ:{ T?~ò~i~L}~cbA~Dad~ty~W~O>~\/~|~`C x}%H}1X}%z}K}
{N}<_~7A~-ψ||Dz|+E|[s|z}^}wO@}-~ċ {Gu{Dz{]Ĭ{f{Zx|[]|ϕM?}R<}Ǝz]YzHħz|z={LNw{\|=>|v|ېI8z/r
z;bz'sMzd6zɬqv{D[{0>|;|yyaIy?yazYvzݮ[{^=c{ФI{R*y߄yfUy`VyyuKzZi{<{z%zȎ~+~ }͇}W0}3}HtЄ}Zk}=~zɇ }!~Єd*s}Y<9wpSwuuVrUW؈|;,뇔{RsѲ;:8q)PCV:4.8Ȅ2?UpVu9ScbփR.ՁNn U388A/ͬδz6߆өn1T\e7݀tXT)$̯̕6;eCʷˆ imw3SƀV7M
\lGNػځNāa5tNzlߴS<H6*