102 Roudebush Hall • Phone: 513-529-3600• Fax: 513-529-3762

Sample Participation and Informed Consent Form

Sample Only

Participation and Informed Consent

Dear ___________:

In the first paragraph: introduce yourself and if applicable, your advisor, and you are a _______ at Miami University and then proceed as below according to your study/research project.

You are invited to participate in a study of people’s self-esteem and self-confidence. I will ask you to complete a few short questionnaires about how you think about yourself. These will be completely anonymous, as you will hand them in as a group, in sealed envelopes, so that I cannot tell who said what. Then we will do two tasks in which I will ask you to make some predictions, and to estimate how confident you are in your answers. Your name will not be associated with your responses in any way. This session should take approximately 45 minutes, for which you will receive 1 hour of research participation credit. Your participation is voluntary and you may withdraw from the session at any time or refuse to answer any questions that make you uncomfortable. If you leave the session before its end, you will receive ___research credit. You will not be asked to do anything that exposes you to risks beyond those of everyday life. The benefit of the study, scientifically, is it will help us understand more about how people think about themselves and their abilities.

If you have further questions about the study, please contact (researcher) at (phone number, e-mail). If you have questions about your rights as a research participant, please call the Office of Advancement of Research and Scholarship at 529-3600 or email: humansubjects@muohio.edu.

Thank you for your participation. We are very grateful for your help and hope that this will be an interesting session for you. You may keep this portion of the page.

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Cut at the line, keep the top section and return the bottom section.

I agree to participate in the study of self-esteem and self-confidence. I understand my participation is voluntary and that my name will not be associated with my responses. By signing below, I acknowledge that I am 18 years or older.

Participant’s signature _______________________________
Date _________________________________