Sample: Informed Consent Form (IRB)

<University Letterhead>

Informed Consent
A Study of Thinking Processes and Eyewitnesses' Memory

Principal Investigator:

Ernest Kim, Ph.D.
Loyola University New Orleans
Department of Psychology, 430 Monroe

Description of the Research: The purpose of this study is to examine aspects of cognitive (thinking) processes. In particular the research will deal with eyewitnesses' memory.

Procedures: If you agree to participate in this study you will be asked to participate in some of the following activities by Dr. Kim and his research associates: puzzle solving, reading, watching television, responding to questions, describing your thought processes and describing emotional states. You will be asked some questions about yourself and you will be asked to complete the "Beck Depression Inventory." These activities will take about 40 minutes of your time.

Benefits and Risks: The benefits that may be derived from this research include: (1) better teaching methods for students, (2) developing methods to help people remember more details about events they have observed or participated in, and (3) possible personal insights. The risks to you may be: a temporary change in mood induced by some questions or responses. If you feel sad or depressed at some point after the research you may wish to contact the Counseling and Career Services, 208 Dana Center, 865-3835. (Note: Other counseling resources may be listed.)

Research Data and Records: Records of your participation in this study will be kept confidential to the extent permitted by law. Your responses will be identified by a code number and results of this research will only be reported as summarized data and will not contain any identifiable individual data. (OR: Information will be collected anonymously. Neither the researcher or anyone else will be able to connect you to data, which will be reported as summarized data.)

Voluntary Participation: Your participation in this study is entirely voluntary. At any time while you are actively participating, you may withdraw your consent and terminate your participation without consequence. Should you have any questions about this project, you may contact the Principal Investigator, Dr. Ernest Kim, whose telephone number appears above.

By signing below, you agree that you have been sufficiently informed of the purpose of the study and any risks and benefits. Please sign two copies and retain one copy for your records.

I have read and understand the information given above, and I sign this consent willingly.
Signature of Participant __________________________________ Date __________

(If you are less than 18 years of age, please obtain the informed consent of a parent or guardian.)
Signature of Parent/Guardian ______________________________ Date __________