https://www.webfx.com/tools/read-able/

https://www.online-utility.org/english/readability_test_and_improve.jsp

Please delete these instructions before submitting to the IRB for review.

Note: Doctoral learners – please use the following template to introduce yourself – I am “insert your name”, a doctoral student under the supervision of Dr. “insert name of your dissertation Chair” in the College of “insert specific college” at Grand Canyon University. The purpose of this study is to “in no more than 3 sentences, please state your study’s purpose”

RESEARCH

· How do I know if I can be in this study? Bullet eligibility criteria (inclusion and exclusion) as stated in the IRB application and recruitment materials.

· You can participate in this study if you:

· Inclusion criteria

· You cannot participate in this study if you:

· Exclusion criteria

· What am I being asked to do? If you agree to be in this study, you will be asked to: (List all research activities with duration for each activity).

· What in 1-2 sentences

· When in 1-2 sentences

· Where in 1-2 sentences

· How in 1-2 sentences

Audiotaping: (If applicable)

I would like to use a voice recorder to record your responses. You (can, or, cannot) still participate if you do not wish to be recorded. Briefly describe how the participants’ identity will be protected.

Videotaping: (If applicable)

I would like to use a video camera to record your actions. Because this tape will show who you are, these extra steps will be taken: (describe added security measures, such as how tapes will be securely transported, labeled, stored, deleted, etc.)

You (can, or, cannot) still participate if you do not wish to be recorded. Briefly describe how the participants’ identity will be protected.

· Who will have access to my information? (myself, and/or, my dissertation chair, and/or, other researchers, and/or, my dissertation committee, etc.)

Participation is voluntary. However, you can leave the study at any time, even if you have not finished, without any penalty or loss of benefits to which you are otherwise entitled. If you decide to stop participation, you may do so by: (describe procedure to be followed if the participant wants to leave the study). If so, I (will use, or, will not use) the information I gathered from you.

· Any possible risks or discomforts? State that there are no foreseeable risks or discomforts associated with this study OR list any physical or psychological risks/discomforts. If applicable, explain any procedures that are experimental.

· Any direct benefits for me? State “no” OR state the direct benefits.

· Any paid compensation for my time? State that participants will not get paid for their participation OR explain what they will get and any instructions/information on how and when they will receive their payment/compensation.

· How will my information and/or identity be protected? Will researchers be able to link participant data back to them? Explain if data will have identifiers or not, how will the data be secured and where? How long? Who will have access?

If you decide to stop participation, you may do so by: (describe procedure to be followed if the participant wants to leave the study). If so, I (will use, or, will not use) the information I gathered from you.

· Will my data include information that can identify me (names, addresses, etc.)? Answer.

· Will researchers assign my data/responses a research ID code to use instead of my name? State “no” or explain.

· If yes, will researchers create a list to link names with their research ID codes? State “N/A” or explain.

· If yes, how will researchers secure the link of names and research ID codes? How long will the link be kept? Who has access? Approximate destroy date? State “N/A” or explain. Answer each question.

· How will my data be protected (electronic and hardcopy)? Where? How long? Who will have access? Approximate destroy or de-identification date? Answer each question.

· Where and how will the signed consent forms be secured? Explain how secured and if the signed consent forms are stored separately from the data.

Once identifiers (name, address, etc.) are removed from these data (identifiable private information or identifiable bio-specimens, whichever is applicable) collected for this study,(the de-identified information or bio-specimen, whichever is applicable) could be used for future research studies or distributed to other investigators for future research studies without additional informed consent from you or your legally authorized representative.

If you have questions about your rights as a subject/participant in this research, or if you feel you have been placed at risk, you can contact the Chair of the Human Subjects Institutional Review Board, through the College of Doctoral Studies at IRB@gcu.edu; (602) 639-7804.

· You have been given an opportunity to read and discuss the informed consent and ask questions about this study;

· You have been given enough time to consider whether or not you want to participate;

· You have read and understand the terms and conditions and agree to take part in this research study;

· You understand your participation is voluntary and that you may stop participation at any time without penalty.

Your signature means that you understand your rights listed above and agree to participate in this study

____________________________________________________ ____________________________

Signature of Participant or Legally Authorized Representative Date

(Your signature indicates that you have ensured the participant has read, understood, and has had the opportunity to ask questions regarding their participation)

Signature of Investigator______________________________________ Date_____________