NORTH CAROLINA AGRICULTURAL AND TECHNICAL STATE UNIVERSITY
INFORMED CONSENT TO PARTICIPATE
IN A RESEARCH SURVEY
If your research involves using a survey, and there is no risk to participants, a simple cover letter will be sufficient to gain your subjects’ informed consent to participate. The letter template below includes all the elements needed in an informed consent document. Please note that minor text changes may be made in order to customize this letter to your needs, but no element of consent should be omitted. For Internet surveys, this letter must be the opening page of your survey.
Study Title:
Principle Investigator:
Faculty Advisor: [Delete if not applicable.]
Dear Respondent,
I am inviting you to participate in a research project to study xxxx. [This research project is funded by xxxx.] You are being asked to participate because you are xxxx [include all criteria for participation, if any]. The procedure involves completing a survey that will take approximately xx minutes. The survey questions will be about xxxx. Through your participation I hope to understand xxxx. You must be at least 18 years old to participate.
I will do my best to keep your information confidential. To help protect your confidentiality, the survey will not contain information that will personally identify you, and I will not ask for your name. All information collected in this study will be kept completely confidential to the extent permitted by law.
[There should be minimal to no risk for a survey; however, if some of the questions may be sensitive or very personal, state that.]
For Paper Survey: If you do not feel comfortable giving your survey to me (or your instructor), you may also [mail it to ____, drop it off at X office, etc.]. If you do not wish to participate, you may turn in a blank survey. I do not anticipate any risks from participating in this research.
For Internet Survey: If data is collected via the Internet and is NOT collected anonymously, include the following statement: Please note that absolute confidentiality cannot be guaranteed due to the limited protections of Internet access. Your participation in this online survey involves risks similar to a person’s everyday use of the Internet.
If you are collecting email addresses in an otherwise anonymous study, such as for a drawing, include the following statement: Your email address will be requested so that we _____. However, it will be stored separately from any data collected in the study.
This project has been approved by the Institutional Review Board (IRB) at North Carolina A&T State University.
Your participation is voluntary and there is no penalty if you do not participate. You may stop the survey at any time or skip any questions you do not wish to answer.
If you have any questions about completing the questionnaire or about being in this study, you may contact me at xxxx. You may also contact my research advisor at xxxx. If you have any study-related concerns or any questions about your rights as a research study participant, you may contact the Office of Research Compliance and Ethics at North Carolina A&T State University at (336) 334-7995.
By completing this survey, you are indicating that you at least 18 years old, have read this document, have had any questions answered, and voluntarily agree to take part in this research study. You may keep this form for your records. [Or for Internet surveys: You may print a copy of this consent agreement for your records.]
Sincerely,
Justin Time
Associate Professor, North Carolina A&T State University