COMPENSATION: There is no
compensation offered for participation in this study.
There are no alternative activities offered for this study.
CONFIDENTIALITY: Efforts will be
made by the research team to keep your personal information private, including
research study survey responses and disclosure will be limited to people who
have a need to review this information. All paper and electronic data collected
from this study will be stored in a secure location on the UNT campus and/or a
secure UNT server for at least three (3) years past the end of this research on
a password protected computer in PI’s campus office.
Research records will be labeled with a pseudonym and the master key
linking names with codes will be maintained in a separate and secure location. Confidentiality will be maintained to the degree possible
given the technology and practices used by the online survey company. Your
participation in this online survey involves risks to confidentiality similar
to a person’s everyday use of the internet.
The results of this study may be
published and/or presented without naming you as a participant. The data
collected about you for this study may be used for future research studies that
are not described in this consent form. If that occurs, an IRB would first
evaluate the use of any information that is identifiable to you, and
confidentiality protection would be maintained.
While absolute confidentiality cannot be
guaranteed, the research team will make every effort to protect the
confidentiality of your records, as described here and to the extent permitted
by law. In addition to the research
team, the following entities may have access to your records, but only on a
need-to-know basis: the U.S. Department
of Health and Human Services, the FDA (federal regulating agencies), the
reviewing IRB, and sponsors of the study.
CONTACT INFORMATION FOR QUESTIONS ABOUT THE STUDY: If you
have any questions about the study you may contact Georgina Fullerton at GeorginaFullerton@my.unt.edu or (817) 600-7346. Any
questions you have regarding your rights as a research subject, or complaints
about the research may be directed to the Office of Research Integrity and
Compliance at 940-565-4643, or by email at untirb@unt.edu.
CONSENT:
●
Your
signature below indicates that you have read, or have had read to you all of
the above.
●
You
confirm that you have been told the possible benefits, risks, and/or
discomforts of the study.
●
You
understand that you do not have to take part in this study and your refusal to
participate or your decision to withdraw will involve no penalty or loss of
rights or benefits.
●
You
understand your rights as a research participant and you voluntarily consent to
participate in this study; you also understand that the study personnel may
choose to stop your participation at any time.
●
By
signing, you are not waiving any of your legal rights.
Please sign below if you are at least 18
years of age and voluntarily agree to participate in this study.
SIGNATURE OF PARTICIPANT DATE
*If you agree to participate, please provide a signed copy of this
form to the researcher team. They will
provide you with a copy to keep for your records.