Sample Informed Consent Form for PSY 270

(from an actual study)

You have been asked to participate in an experiment conducted by senior psychology majors Jennifer Phillips and Shannon Achey under the direction of Dr. Anita Meehan. In this study, you will be asked to look at words on a screen and then complete several measures of verbal ability. For example, you will be asked to count the number of consonants in a word or to fill in a blank with the first word that comes to mind. The entire experiment should take 45-50 minutes.

No deception is involved in this study, nor are there any risks to you as a participant. Participation in this study should result in a greater understanding of how research is conducted and in an understanding of mental functions.

All information from this experiment will be strictly confidential so that your name will not be used in reporting the results. The only place that your name will even appear is on this informed consent form. None of the answer sheets that you will be given for the verbal tasks ask for your name.

Your participation in this study is completely voluntary and you may withdraw from this experiment at any time without penalty. If you wish to withdraw, simply notify the researchers. Please feel free to contact Dr. Anita Meehan if you have any questions or concerns about the study at any time.

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I understand the study as outlined above and have read this description. I verify that I am 18 years of age or older and that I understand my participation in this experiment is voluntary. I may refuse to participate or withdraw from this experiment at any time without penalty.

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Signature of participant Date