ÐÏà¡±á>þÿ <>þÿÿÿ;ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿì¥Á ð¿bjbjÂõÂõ ²& Ÿœ_ Ÿœ_ÂZÿÿÿÿÿÿ·` ` ¥¥¥¥¥4ÿÿÿÿÙÙÙhAU$Ùô&&yyyyyÁÁÁs&u&u&u&u&u&u&$)¶Ð+Ú™&¥ÁÁÁÁÁ™&¥¥yyH®&uuuÁX¥y¥ys&uÁs&uuŽo$h‡%ÿÿÿÿàš`L,Ôÿÿÿÿ.×$_&Ä&0ô&ç$ ª,G.ª, ‡%‡%ª,¥›%ÄÁÁuÁÁÁÁÁ™&™&uÁÁÁô&ÁÁÁÁÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿª,ÁÁÁÁÁÁÁÁÁ` k: Researchers may use this Informed Consent Template as a guide to create an informed consent form and/or letter for their projects. If verbal informed consent is used, a transcript of the script human subjects will hear must be filed with your HSIRB proposal. In the form/letter, please make sure you provide all of the following information: Indicate the title of research, who you are, your relationship to Ì½»¨ÉçÇø College, and your reason for conducting the research. Also indicate the sponsor of the research including any funding organizations. Describe the subject's participation in this research. Describe the expected duration of the subject's participation including whether or not you will be contacting the participant on a single occasion or on multiple occasions. Since there is no such thing as “no risk” in human endeavors, describe the anticipated level of risk presented by this research to the subject. If the risk is no greater than that experienced in the participant’s normal life, confirm this. Provide contact information for a person or office in the event of unanticipated physical or psychological injury during or after the research. For subjects recruited at Ì½»¨ÉçÇø College, you need to provide the following contacts: The Health Center 250 W. Laurel Street Bethlehem, PA 18018 (610) 861-1567 The Counseling Center 1301 Main Street Bethlehem, PA 18018 (610) 861-1510 The Office of Campus Safety and Police 119 W. Greenwich Street Bethlehem, PA 18018 (610) 861-1421 (610) 861-1465 For subjects who are not members of the Ì½»¨ÉçÇø College community, please provide the appropriate contacts for the institution from whence the population is drawn. For example, if your sample population consists of elementary school children, please provide the contact information for the school’s nurse’s office and counseling office. Describe the subject's anticipated benefit, if any, for participating in this research. If none, say so. Describe how and the extent to which the subject's records/responses will be kept confidential during the research. Describe what will happen to the subject's records at the conclusion of the research. Be specific. For example, if dealing with paper surveys, instead of saying that they will be destroyed, indicate that they will be shredded. If you are recording interviews, you might indicate that the tapes will be magnetized or written over. Indicate that participation in this research is voluntary. State that refusal to participate will involve no penalty or loss of benefits to which the subject is otherwise entitled. State that the subject may discontinue participation at any time. List the potential consequences, if any, of withdrawing from this research. If none, state so. Describe in detail the process for withdrawing from this research. Provide contact information for a person or office to answer questions about this research and the subject's rights. (For student research, this is generally the faculty sponsor). In the name of student safety, we recommend that students do not distribute their personal phone numbers or email addresses for these inquiries, but instead either use their Ì½»¨ÉçÇø email addresses or create a special email account for the duration of the research. With the approval of the host academic department, students can use department phone numbers as a contact point. At the end of the informed consent form and/or letter, you typically include the following signature statements: I attest that I am at least 18 years of age or a Ì½»¨ÉçÇø College Student, that I read and understand this consent form, and that I received a copy of it. Subject signature: ____________________________________ Date: ___________________________ I attest that I am the subject's legally authorized guardian (representative), that I read and understand this consent form, and that I received a copy. 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