Note (delete this statement in the final copy): Insert applicable information in the as noted in red. Delete the language that does not apply. Do not delete any of the major headings as these are required by regulation and/or local policy.
Consent to Participate in Internet Research
Identification of Investigator and Purpose of Study
You are invited to participate in a research study, entitled “[Insert study title].” The study is being conducted by [Insert researcher(s) name(s)] of the University of Notre Dame, who may be reached at [Insert telephone number and/or email address].
The purpose of this research study is to [Insert a description of the purpose of the study]. Your participation in the study will contribute to a better understanding of [Describe of what you are evaluating]. You are free to contact the investigator at the above address and phone number to discuss the study. You must be at least 18 years old to participate.
If you agree to participate:
· The [Insert the activity to be completed; e.g., survey, other activity] will evaluate [Insert a description of what will be evaluated] and will take approximately [Insert the approximate time involved for the participant] of your time.
· You [will or will not] be compensated [If compensated, insert compensation information]
Risks/Benefits/Confidentiality of Data
There are [no known risks] or [some possible risks such as loss of privacy or confidentiality or some discomfort which could cause you to feel uncomfortable, embarrassed, sad, tired, etc]. There will be no costs for participating, nor will you benefit from participating. Your name and email address [will or will not] be kept during the data collection phase [for tracking purposes only]. A limited number of research team members will have access to the data during data collection. [If applicable, add “Identifying information will be stripped from the final dataset.”].
Participation or Withdrawal
Your participation in this study is voluntary. You may decline to answer any question and you have the right to withdraw from participation at any time. Withdrawal will not affect your relationship with the University of Notre Dame in anyway. If you do not want to participate either simply stop participating or close the browser window.
If you do not want to receive any more reminders, you may email us at [Insert email address] or follow this link to opt out of future emails [Insert link].
Contacts
If you have any questions about the study or need to update your email address contact the researcher [Insert PI name] at [Insert phone number and email address]. This study has been reviewed by the University of Notre Dame Institutional Review Board and the study number is [Insert study number].
Questions about your rights as a research participant
For questions about your rights or any dissatisfaction with any part of this study, you can contact, anonymously if you wish, the Notre Dame Research Compliance Office, at 574-631-1461 or by email at
If you agree to participate, click on the following link [Insert link to study]
The password for the study is [Insert password or information to logon to the study].
Please print a copy of this document for your records.