ECT/HCI 441
Informed Consent Example
Informed Consent Agreement
Page 1 of 1
Project Title: Departmental Factors in Gendered Attrition from IT Majors
Please read this consent agreement carefully before you decide to participate in the study.
Purpose of the research study:The purpose of this study is to identify factors affecting attrition from undergraduate Computer Science Programs.
What you will do in the study: You will be interviewed about your experiences and observations as a member of this CS department. With your permission, the interview will be audio taped.The audio taped interviews will be transcribed by professional transcribers and analyzed by Joanne Cohoon. When the study is complete, audiotapes will be archived with other data collected for this study for potential further analysis. At no time will the confidentiality of this research be violated by associated identifying information with responses.
Time required: approximately 1 hour per interview, 2 hours per focus group.
Risks: There are no anticipated risks.
Benefits: There are no direct benefits to you for participating in this research study. The study results will help us understand how to improve retention of qualified students in Computer Science. Data on your department’s characteristics and the average characteristics of CS departments will be provided when analysis is complete.
Confidentiality: The information that you give in the study will be handled confidentially. Your information will be assigned a code number. The list connecting your name to this number will be kept in a separate computer file. When the study is completed and the data have been analyzed, this list will be destroyed. Your name will not be used in any report or made public in any way.
Voluntary participation: Your participation in the study is complete voluntary.
Right to withdraw from the study: You have the right to withdraw from the study at any time without penalty.
How to withdraw from the study: If you want to withdraw from the study, simple leave or state that you wish to end the interview. There is no penalty for withdrawing. If you choose to withdraw, you audio tape will be destroyed.
Payment:You will receive no payment for participating in this interview.
Who to contact if you have questions about the study:
Xxxxxxxxxxxxxxxxxxxxxxx
Who to contact about your rights in the study:
Yyyyyyyyyyyyyyyyyyyyyyyyyy
Agreement:
I
agree to participate in the research study described above.
Signature:____________________________________ Date_______________________
You will receive a copy of this form for your records.