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IRB-PHS Sample Consent Form • Age ≥ 18

Factors Affecting Choice of Dating and Marriage Partners

Investigator (Faculty/Staff): Dr. Tim Baylor Phone: (570) 484-2333

Campus Address: 142 Akeley

Co-Investigators/Students: Dr. Robert Moore III

We invite you to participate in a study of people’s choice of dating and marriage partners. You have been selected for this study because you are at least 18 years of age.

Investigational Procedures

If you choose to participate in this study, you will be asked to answer a series of questions that includes basic information about yourself and your choice of potential dating and marriage partners. If you agree to a personal interview, your responses will be voice recorded. It should take you no more than 15-20 minutes to compete the survey.

Risks and Benefits

This investigational procedure does not pose any more risk than you experience in normal daily living. If you participate in this study, you may experience the fulfillment that comes from being able to express your own thoughts and the satisfaction that comes with research and discovery. We appreciate your assistance in our research effort and hope you will find the experience rewarding. We do not promise, however, that you will receive any of these benefits.

Privacy of Records

Any information that we learn about you that can be traced to you will be used responsibly and will be protected against release to unauthorized persons. Your data record will likely be shown to members of the investigation team. If you sign this form you have given us permission to release information to these persons. The results of this study may be published in the professional sociological literature, but no publication will contain information that will identify you.


Payment

You will receive no payment for participating in this study.

Conclusion

If you are a member of the Lock Haven University community, your decision whether or not to participate in this study is voluntary and will not affect your standing at Lock Haven University of Pennsylvania. If you are not a member of Lock Haven University, your decision to participate in the study is also voluntary. Even if you decide to participate, you may stop and withdraw at any time. Of course we will tell you anything during the study that may help you decide whether to continue participation. You are making a decision whether or not you will participate in this study. If you sign this form, you will have agreed that you will participate based on reading and understanding this form. If you have any questions, please ask one of the investigators identified on the front of this form.

If you have any questions regarding research participants’ rights, please contact Dr. Luke Haile, Chair, Lock Haven University Institutional Review Board for the Protection of Human Subjects at (570) 484-3021.

You will receive an unsigned copy of this form.

Date
Participant Signature

Date
Member of Investigational Team Signature