Human Informed Consent Form

Human Research on Psychological
Behavior on Attention

You are invited to participate in a research study by student research investigators from the Social Sciences Department of Some University for their thesis. Please note that your participation in this study is voluntary.

Please read the details of this informed consent below. If you have questions, please do let us know. After going through all the information, you may decide if you wish to participate by signing this form.

PURPOSE OF THE STUDY

This study is designed to examine human behavior on attention. 

PROCEDURES

If in case you participate in this study, you will receive an oral interview with our researcher for your personal and basic information. You will then answer a form that may take 30 minutes for an IQ test. After this, you will then answer a 30-minute psychological evaluation. These will be assessed by our researchers. 

POTENTIAL RISKS

You might experience mental or psychological discomfort or uneasiness when answering the questions. Please note that in case of physical or mental injuries happen during the participation, the institution, nor the sponsors of this study cannot immediately provide medical assistance or compensate the participant.

BENEFITS

There is no direct benefit to the participant in this study. However, should the participant wish to have a copy of the results of the tests, we will be able to gladly give the participant a copy of the result.

CONFIDENTIALITY

We respect everyone's privacy. Any information we have obtained during the study shall remain confidential with us and will not be disclosed to anyone, except for statistical data purposes only. The records shall be stored in a secure database and shall be destroyed after 2 years if in case there is no use for the data anymore.

PARTICIPATION

It is up to you whether you decide to take part in this study. If you decide to take part in this study and decide to withdraw later, we will respect that and our relationship with you will not be affected. Your data, if there is any, shall be destroyed as if you never filled out any form or have been interviewed. In case there are certain questions that you are uncomfortable answering, please let us know.

QUESTIONS

In case you have questions, you may get in touch with our researchers:

John Doe
393-330-3330
Principal Investigator

Jane Doe
339-330-4440
Co-Investigator

I have read the information above or it has been read to me and I understand the procedures and the intention of the study. I have had the opportunity to ask questions and which questions were clearly answered accordingly and to my satisfaction. I agree to take part in this study and voluntarily sign this informed consent. I have been informed that upon submission a receipt copy of this informed consent shall be sent to my email.