Table C–2

Sample Informed-Consent Form

Students taking PSY 455, Research Design, are investigating the effects of noise and sleep deprivation on anxiety.

If you participate in and complete this study, the investigators will interrupt your sleep for one hour on two consecutive nights. During that hour, you will be  woken up, asked to fill out two questionnaires, and your pulse and blood pressure will be measured several times.

You will be asked to spend two nights in a special dorm room so that your sleep can be monitored. In addition, it will take approximately 60 minutes each night for the blood pressure and questionnaire measures to be completed.

You will receive $20 for participating in the study.

Physical injury, psychological injury, or deception are not part of this study. In addition, all your responses and answers will be held confidential. No one other than the investigators will see information about your particular responses.

Any questions you have regarding this project should be addressed to the investigators or to Dr. ________________, faculty supervisor (phone:           , e-mail: ).

If you agree to participate in this study, please sign the following statement.

I have read the above Consent Form and understand the proposed project. I consent to participate in this study. I understand that I can quit the study at any time. Finally, I will be paid $20 whether or not I complete the study.

 

Signature                                                       Date

 


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