Edinboro University of Pennsylvania

Name of StudyPage 1 of 2

IRB Approved

Example Informed Consent for Online Surveys

EDINBORO UNIVERSITY OF PENNSYLVANIA

Edinboro, Pennsylvania

CONSENT TO PARTICIPATE IN A RESEARCH STUDY

Title of Study: Use the exact name of the study as it appears in the IRB application

Principal & Co- investigators:

Introduction

“You are being asked by _____ to be in a research survey. This consent describes your role as a participant in the survey.”

Study Purpose

Include purpose(s) of the survey and why the individual is being “asked” to participate. It can also indicate why the individual was chosen.

What Will Happen During the Study?

Outline the survey procedures, including the estimated amount of time the survey will take. You should include the topics to be covered by the survey questions. This should be VERY clear and in language that someone who is not familiar with the study area would understand. Think - What information would I want to know about a survey before agreeing to participate?

What Are the Possible Risks or Discomforts?

Explain the most serious and common risks that could happen as a consequence of participating in the survey (include physical, emotional, psychological, social, financial, and spiritual effects). While most surveys involve no or very minimal risk it is advisable to add a line that indicates that if the participant “should feel uncomfortable about any question(s), then you may skip it or elect to stop taking the survey. “

What Are the Possible Benefits of Participating in This Study?

Include benefits to the participant OR to society as a whole.

How Will the Collected Data Be Kept Confidential?

Here you need to explain how confidentiality and/or anonymity will be protected. This includes tracing IP addresses or e-mail information (i.e., Surveys will NOT be linked to IP addresses and if you elect to leave your e-mail address, it will NOT be connected to your responses on the survey). Explain how information from the study will be kept, who will have access to it, whether individual responses will be present or just the aggregated ones, and if, ultimately, the data will be destroyed.

What Happens If I Have More Questions?

“Your questions about a research-related injury or the research study will be answered by_____ at (give PI e-mail address). If you have a question about your rights as a research participant you can contact the chairperson of Edinboro University Institutional Review Board, at “

What Will Happen If You Decide Not To Be in the Study?

“Your participation is strictly voluntary; you may elect not to answer any or all of the questions in the survey. If you change your mind about participating, there will be no penalty, retribution, or repercussion for withdrawing from the study. To stop taking the survey, exit out of your web browser. “

“By clicking the next button and beginning the survey, you acknowledge that you have read the informed consent and agree to participate in the survey. You also acknowledge that you are at least 18 years of age and that you understand that you have the right not to answer any or all of the questions in the survey. Finally, you understand that you can quit the survey, without penalty, at any time. “

Rev. 09/22/09