Andrews University
Behavioral Science Department
Consent Form

Title of study: [Title Goes Here]
[Principle Investigator Names]
Behavioral Science Department, Andrews University 
4141 Administration Dr
Berrien Springs, MI 49104-0030
[investigator email address]

Research Supervisor:
Dr. Karl Bailey
Behavioral Science Department, Andrews University 
4141 Administration Dr
Berrien Springs, MI 49104-0030
kgbailey@andrews.edu
(269) 471-3577

Purpose:
	[why are you doing this experiment? talk about the general field, not your research question itself. Your goal here is to inform the subject about why, in general, these sorts of experiments are run. Specific questions, hypotheses, and so forth should wait until after the experiment is done. As with below, your goal is to help the subjects make and informed decision about participating in your study.]

Inclusion Criteria:
	I have been told that for me to participate in this study I must be [inclusion criteria go here – what do your subjects need to have (corrected to normal or normal vision; older than 18; native speaker of English; from Agentina; etc.) – and what must your subjects not have (previous experience with a class; a significant other; an extra toe; etc.)].

Procedure:
	I have been told that I will be asked to [describe procedure here – this may require multiple sentences. ONLY list what your subjects will need to do; not your research question, hypotheses or particular within subject manipulations.].

Risks and Discomforts:
	[sample follows – if there are specific risks, please indicate or talk to me about how to proceed] I have been told that there are no known risks for participating in this study. I have been told that data recorded during this experiment will be assigned a random number that will never be associated with my name or other identifying information during analysis. I have been told that the data collected from this experiment will be analyzed a group, rather than individual, data.
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Benefits and Results:
	[sample follows] I understand that I may not receive any direct benefits from participating in this study [note: unless you are providing a candy bar or some such payment].  I understand that the results may help undergraduate psychology research students to better understand [the topic of your study] and to design future studies to inform the larger field of [cognitive psychology].  I understand that the information collected during this study may be presented in the current [PSYC445 Cognitive Psychology] class, and that the researchers listed above will be analyzing the data in partial fulfillment of the requirements for that course.

Voluntary Participation:
	I have been told that my participation in this study is voluntary.  I have been told that I may discontinue my participation in this study at any time without any penalty or prejudice.  I also have been told that there is [no compensation] in return for my participation.

I have been told that I may contact the researcher, [your name], at [email or phone], investigator’s research supervisor, Dr. Karl Bailey, at (269)-471-3577 or kgbailey@andrews.edu. I have been told that if I wish to contact an impartial third party, I may contact the Chair of the Behavioral Sciences Department at 471-3152 for information and assistance.

I have read the contents of this consent form and have listened to the verbal explanation given by the investigator. My questions have been answered to my satisfaction. I hereby give voluntary consent to participate in this study. If I have additional questions or concerns, I may contact [your name] using the information above. I have also been offered a copy of this consent form.

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Signature of Subject						Date

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