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Debriefing/Additional Information
Permission to Use Information Collected in a Research Study
Clemson University
[Title of the Study]
[Include the following paragraph if you will deceive or conceal information from the participants]
Thank you for taking part in this study. You were told at the beginning of the study that (describe any incorrect information that was given). Now that you have completed the study, we want to let you know that (explain the true information that was withheld in easily understood language;. this should include a full explanation of all elements of consent that were waived for this study). We did not disclose all relevant information to you during the study because (explain reason for deception/concealment).
If applicable, include the following statement: In the event that you experience a negative reaction to participating in this research, consider engaging in self-care activities that allow you to regain your balance. Should you need to connect with someone, consider the following confidential resources. (remove any resource that is not applicable to the study)
· Mental Health America of Greenville County’s CRISISline: (864) 271-8888. Free, 24/7 crisis phone line.
· Crisis Chat: http://www.crisischat.org/ Free chat line available 2PM to 2AM, 7 days/week.
· Crisis Text Line: Text “START” to 741-741 Service is free through most major phone service carriers and available 24/7.
· National Sexual Assault Online Hotline: http://apps.rainn.org/ohl-bridge/ Free, 24/7 online chat service.
· Contact a mental health professional of your choice, at your own expense.
· Access psychological care through Counseling and Psychological Services at Redfern Health Center. Call (864) 656-2451 during business hours.
[Upon participant request, this information must be made available to participants in writing.]
If applicable, include the following statement: If you would like a copy of the results of the study once it is completed, you may contact (researcher’s name) at (contact information).
Because we did (conceal information from you OR not tell you the truth) at the beginning of this study, you now have the option to have us destroy the information we just collected or you can allow us to keep your information and use it for research purposes.
(remove section requesting initials and signature line if you requested a waiver of documentation of informed consent)
Please initial your choice.
______I give permission to have my information used in this research project.
______I DO NOT give permission to have my information used in this research project. Please destroy all information collected from me immediately.
If you choose to stop taking part in this study later, the information you have already provided will be used in a confidential manner
If applicable, include the following statement: Please remember that some of your classmates may also be signed up for this study. If they knew (describe information that was withheld), that could negatively effect the results of this study, thereby wasting your time and ours. Therefore, we would appreciate it if you would not share this additional information with others who may be taking part in this study.
Thank you again for taking part in this study!
Participant’s signature: ______Date: ______
IRB Number:Approved:
Expiration: / Page 1 of 2