The Mind Research Network

Consent to Participate in Research
Initial Questionnaire to Determine Eligibility to Participate

Introduction
Thank you for volunteering to participate in a research study at The Mind Research Network. These studies are being conducted by Dr. Matthew S. Shane from the Mind Research Network (MRN), and his associates at MRN and The Center for Alcohol, Substance Abuse and Addiction (CASAA).

The studies seek to better understand what factors may cause people to make bad decisions. Much of our research focuses on issues related to substance abuse and criminal behavior, and you are being asked to participate because you are currently on probation or parole. Participants who volunteer to participate in our studies generally complete interviews and tasks that allow us to learn about them, their life, and their personality, and also undergo a safe, non-invasive MRI brain scan that allows us to evaluate the brain

What will happen if I decide to participate?
Right now you will only have to complete this questionnaire. These questions are designed to help us gather some basic information about you, which we’ll use to determine what studies you are able to qualify for. We’ll also ask you for contact information – an email or a phone number – which we will use to contact you to schedule you if you qualify for any studies. It should take approximately 10 minutes of your time. We try to get back to all eligible participants within 48 hours.

What are the risks of being in this study?
Confidentiality/Privacy: All answers collected on this questionnaire are confidential and will not be shared outside of the research lab. We will take measures to protect your privacy and the security of all your personal information. The questionnaire website is secured with SSL encryption, and all data is stored in a password protected electronic format. The only personally identifying information in these surveys will be your first name, and the phone number and/or email address you provide, and this information will be stored as separate database entries connected to the survey data by your SurveyMonkey subject number. If you participate in the full study, your contact information will be destroyed, and your survey data will be stored in locked file cabinets at MRN/CASAA and/or on our secured server. If you do not participate in the full study, both the contact and survey information you provide today will be destroyed.

Will I be paid for taking part in this study?
If you participate in the full study, you will be paid a standard rate of $20.00/hour for every hour you spend participating.

Who can I call with questions or complaints about this study?
If you have any questions, concerns or complaints, you may contact Dr. Matthew Shane or his associates at participation@mrn.org. If you would like to speak with someone other than the research team, you may call the UNMHSC HRRC at (505) 272-1129.

What are my rights as a research subject?
If you have questions regarding your rights as a research subject, you may call the HRRC at (505) 272-1129 or visit the HRRC website at http://hsc.unm.edu/som/research/hrrc/.

Consent to screening.
You are making a decision whether to participate in this pre-screening process. Your signature below indicates that you have read the information above. By signing this consent form, you are not waiving your legal rights as a research subject.

Please provide us with your first and last name, an email address, and a telephone number. This information will be used to contact you if we find that you meet our eligibility requirements to participate in one or more of our studies. If you do not fill out this information completely and correctly we may not be able to contact you if you are eligible.

HRPO #: 1 0 - 3 1 5 Page 2 of 2 Version: 05/15/2013
APPROVED: 05/23/2013 OFFICIAL USE ONLY EXPIRES: 07/19/2014
The University of New Mexico Institutional Review Board (HRRC/MCIRB)