Sample Consent Form for College Student Participant

Purpose and Procedures: This study is intended to assess college students' feelings and attitudes
about taking tests. If you agree to take part in this research, you will be asked to complete an
achievement test and several follow-up questionnaires. You will be given feedback regarding
your performance on the achievement test. You will be asked to complete the test and surveys
today in this location. This will take about 45 minutes.

Voluntariness: Your participation in this research is voluntary. You may refuse to participate,
discontinue participation, or skip any questions you don’t wish to answer at any time without
penalty or loss of the benefits to which you are otherwise entitled. Your decision will not affect
your grades or status at this university.

Risks and Benefits: You may experience some mild, temporary discomfort relating to taking an
achievement test, about your performance on the test, or associated with the post-test
questionnaires, as they concern your feelings and attitudes. Other than receiving extra credit in
exchange for your participation, you will probably not receive any direct benefits from
participating in this research. However, your participation may help researchers and clinicians
understand certain psychological traits.

Compensation: In return for your participation, you will receive extra credit as arranged with
your course instructor. If you do not wish to participate in this study, you will have opportunities
to participate in other research studies that will require an equal amount of time to complete (i.e.,
45 minutes) and for which you can receive the same amount of extra credit.

Confidentiality: Only the principal researcher will have access to research results associated
with your identity. In the event of publication of this research, no personally identifying
information will be disclosed. To make sure your participation is confidential, please do not
provide any personally identifying information on the questionnaires and place your signed
consent form and completed tests in separate envelopes.

Who to Contact with Questions: Questions about this research study should be directed to the
primary investigator and person in charge, INVESTIGATOR NAME., or her supervisor,
SUPERVISOR NAME. They can be reached at CONTACT INFORMATION. Questions about
your rights as a research participant should be directed to the UIUC Institutional Review Board
Office at 333.2670; irb@uiuc.edu. You will receive a copy of this consent form.

I certify that I have read this form and volunteer to participate in this research study.

_________________________________
(Print) Name

_________________________________ Date: _________________

Signature

IRB Sample 50582467.doc Last revised on 05 Jan 2005