Reaction Time

Review Board Form

You will use this form to get permission from the Review Board to conduct your study. You may not begin collecting data until you receive a signed copy of your form. The purpose of this form is to enable the Board to verify both the safety and confidentiality of all participants. It should also help you to think more about your study and to plan it before beginning.

Title of Experiment ______________________________________________

Name(s) of Researchers____________________________________________________________________

1. Briefly describe the purpose of the experiment.

2. Who will be the participants? How will they be chosen?

3. How will confidentiality be maintained? How will you identify data associated with each participant?

4. Are there any potential risks, physical or psychological, to participants? If so, what? How will you, as the researcher, minimize these risks?

5. Describe your debriefing procedures.

6. Describe the procedures of the study. Give enough detail so that the Board can make a judgment about your study.

Include copies of any instruments as well as your consent form.

Statement of Consent: I have been informed of the nature of the experiment and have read all of the information above regarding the experiment. I have received answers to any questions that I may have. I give my informed consent to participating in this experiment.

Name of participant: ______________________

Signature of participant: ___________________. Date: ___________________

_______________________________ ___________ Researchers Signatures (may be electronic) Date