Consent Form for “Reservation Prototype Evaluation”
You are being asked to be a volunteer in a research study
I agree to take part in a research study titled “Reservation Prototype Evaluation”, which is being conducted by ITEC4130 students (Human Computer Interaction), Georgia Gwinnett College. I do not have to take part in this study; I can stop taking part at any time without giving any reason, and without penalty. I can ask to have information related to me removed from the research records or destroyed.
1: REASON/PURPOSE
The purpose of the study is to test a new way to reserve rooms in the library. The current system puts too much maintenance efforts on the library staff members and thus a more digitalized system is trying to be implemented.
2: COMPENSATION AND BENEFITS
There is no compensation or extra-credit for participants. There is no immediate benefit to volunteers; however, this is an opportunity to revise reservation systems here at GGC
3: PROCEDURES
· Prototype Testing: If I choose to participate in this study, I will be given a prototype of a reservation style program. I will be asked if the prototype fits well and if there is anything that I didn’t like about the prototype.
4: DISCOMFORTS, STRESSES or RISKS
No risks are expected.
5: CONFIDENTIALITY
All information concerning me will be kept confidential: My instructor will not know whether I have agreed to participate in this study or not. My instructor will not be able to associate my responses with my name. My identity will be coded, and all data will be kept in a secured, limited access location. If information about me is published, it will be written in a way that I cannot be recognized. However, research records may be obtained by court order.
6: FURTHER QUESTIONS
The researchers will answer any further questions about the research, now or during the course of the project, and can be reached by telephone:
§ Jim Rowan (678-524-6403)
7: FINAL AGREEMENT & CONSENT FORM COPY
Minors should not participate in this study. By signing below, I certify that I am 18 years or older. I understand the procedures described above. My questions have been answered to my satisfaction. I have been given a copy of this form. Please check one of the following:
_____ Yes, I agree to allow my data to be used for this research study.
_____ No, I do not give permission for my data to be used for this research study.
Human Subjects Guidelines / Page 1______
Signature of Participant. Date
______
Printed Name of Participant
______
Signature of Researcher. Date
______
Signature of Researcher. Date
For questions or problems about your rights please call, write, or email Dr. Juliana Lancaster: (678-466-4979); Chair, Institutional Review Board,1000 University Center Lane, Lawrenceville GA 30043;
< >