Consent to Participate in Research

Spring, 2007

Title of the Study

Researcher:

Phone:

Email:

Thank you for agreeing to participate in this study which will take place from (date) to (date).

The purpose of this study is:

1. To fulfill a course requirement for EDU 496, Research Seminar taught by Dr. Merryellen Towey Schulz at College of Saint Mary.

2. To gain insight and experience in the topic of _________________________

The methods to be used to collect information for this study are explained below.

(describe your methods briefly here – use a small font and try to keep it to one page)

I will use the information from this study to write a report and present the findings at the CSM Scholars’ Day, April 25^th.. This report will be read by the course instructor and other students in the class.

I guarantee that the following conditions will be met:

1. Your real name will not be used at any point of information collection, or in the written report; instead, you and any other person and place names involved in the study will be given pseudonyms that will be used in all verbal and written records and reports.

2. If you grant permission for audio taping, no audio tapes will be used for any purpose other than to do this study, and will not be played for any reason other than to do this study. These tapes will be destroyed upon completions of the project.

3. Your participation in this research is voluntary; you have the right to withdraw at any point of the study, for any reason, and without any prejudice, and the information collected and records and reports written will be turned over to you.

4. You will receive a copy of the report that is handed in to the instructor.

Do you grant permission to be quoted directly? Yes ______ No ______

Do you grant permission to be audiotaped? Yes ______ No ______

I agree to the terms: Respondent ______________________________________ Date _____________

I agree to the terms: Researcher _______________________________________ Date _____________