0.10 Appendix f  (Page 2/2)

RISKS/DISCOMFORTS

There are no foreseeable risks to you in participating in this research project.

Benefits

While you may not directly benefit from participation, your participation could help the investigator and others in the field to better understand how faculty make use of an e-textbook package to design instruction.

ALTERNATIVES

Participation in this project is voluntary and the only alternative to this project is non-participation.

PUBLICATION STATEMENT

The results of this study will be published as a dissertation, and may be published in professional and/or scientific journals. It may also be used for educational purposes or for professional presentations. The data collected may be used in future research activities, such as a longitudinal study, in which case you will be sent a new consent form. However, at no time will individual subjects be identified.

SUBJECT RIGHTS

1. I understand that informed consent is required of all persons participating in this project.
2. All procedures have been explained to me and all my questions have been answered to my satisfaction.
3. Any risks and/or discomforts have been explained to me.
4. Any benefits have been explained to me.
5. I understand that, if I have any questions, I may contact Jeannette Dixon at 713-868-1091. I may also contact Dr. Melissa Pierson, faculty sponsor, at 713-743-4961.
6. I have been told that I may refuse to participate or to stop my participation in this project at any time before or during the project. I may also refuse to answer any question.
7. ANY QUESTIONS REGARDING MY RIGHTS AS A RESEARCH SUBJECT MAY BE ADDRESSED TO THE UNIVERSITY OF HOUSTON COMMITTEE FOR THE PROTECTION OF HUMAN SUBJECTS (713-743-9204). ALL RESEARCH PROJECTS THAT ARE CARRIED OUT BY INVESTIGATORS AT THE UNIVERSITY OF HOUSTON ARE GOVERNED BY REQUIREMENTS OF THE UNIVERSITY AND THE FEDERAL GOVERNMENT.
8. All information that is obtained in connection with this project and that can be identified with me will remain confidential as far as possible within legal limits. Information gained from this study that can be identified with me may be released to no one other than the principal investigator and Dr. Melissa Pierson. The results may be published in scientific journals, professional publications, or educational presentations without identifying me by name.

I HAVE READ (OR HAVE HAD READ TO ME) THE CONTENTS OF THIS CONSENT FORM AND HAVE BEEN ENCOURAGED TO ASK QUESTIONS. I HAVE RECEIVED ANSWERS TO MY QUESTIONS. I GIVE MY CONSENT TO PARTICIPATE IN THIS STUDY. I HAVE RECEIVED (OR WILL RECEIVE) A COPY OF THIS FORM FOR MY RECORDS AND FUTURE REFERENCE.

Study Subject (print name):

Signature of Study Subject:

Date:

I HAVE READ THIS FORM TO THE SUBJECT AND/OR THE SUBJECT HAS READ THIS FORM. AN EXPLANATION OF THE RESEARCH WAS GIVEN AND QUESTIONS FROM THE SUBJECT WERE SOLICITED AND ANSWERED TO THE SUBJECT’S SATISFACTION. IN MY JUDGMENT, THE SUBJECT HAS DEMONSTRATED COMPREHENSION OF THE INFORMATION.

Principal Investigator (print name and title):

Signature of Principal Investigator:

Date: