| Statement of Voluntary Consent
To participate as a subject in the study described below
Date: January 14, 2004
Name of Study: The effects of work experience on college performance
Purpose of Study: To better understand the role of work experience and college performance and to make recommendations to the college administration regarding the college work study program.
Primary Researcher(s): Dr. Christopher L. Heffner, [Affiliation]
Contact Information: [Include office phone, school or organization address, and information regarding any committees on ethical research within your organization]
As a volunteer participant in the above mentioned research, I understand that I will be asked to complete a survey that will ask questions related to my work experience and college grades. The survey typically takes about 20 minutes to complete although this time can vary depending on each subject. I also understand that I may consider some of the questions personal in nature but that the information I provide will be used exclusively for this project and will in no way be associated with my name, address, student ID or any other identifiable information.
As a participant in this study I am aware that the questions on the research survey may cause anxiety or stress depending on my personal situation but that most find the experience harmless and even enjoyable. As a participant, I am aware that the responses I provide may assist future college students at this University and perhaps other colleges across the country.
By signing below, I state that I have read this consent form in its entirety and that all of my questions have been answered. I understand that I may withdrawal from this study at any time and that my participation or lack of participation will in no way affect my status as a [student, patient, employee, etc.]
Subject Signature ________________________ Date ______
Witness Signature ________________________ Date ______
|
