The Signature PJ

Consent Form

(Your Name)

The University of West Alabama

Research Proposal Title:

 1.  What is the purpose of the study?

 2.  How was I chosen?

 3.  What will be involved in participating?

 4.  Who will know what I say?

 5.  What risks and benefits are associated with participation?

 6.  What are my rights as a respondent? You may ask any questions regarding the research, and they will be answered fully.  Your participation in the study is voluntary; you may withdraw at any time.

 7.  What will be published?  Following the completion of this research proposal, I plan to maintain my records for use in future publications and scholarly presentations.  I plan to publish my findings as articles in professional journals, with the ultimate goal of publishing a book or a chapter in a book.

 8.  If I want more information, whom can I contact about the study? This study has been approved by the University of West Alabama’s Internal Review Board for the Protection of Human Subjects.  This board can be contacted through the office of Mrs. Patricia Pratt.  In addition, my research advisor, name of your professor, can be contacted at telephone number.

 __________________________             ___________________________________

(Your name), Project Director                 Respondent’s signature, Date

 Note:  The consent format presented above should be used in the appendix of your research proposal.  Items 1 through 5 should be completed as though you are answering the questions of the respondent about your research project.

 Also, if you are conducting research that is covered by the Department of Health and Human Services requirements for minors, you will be required to complete a consent form for minors as shown in your textbook.

This consent form has all the required information from Federal law.

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