Student Substance Assessment

Informed Consent

 
 20% 
INFORMED CONSENT FORM

Examining PLU Substance Use
Lead Researcher: Garrett A. Gilchrist, Ph.D., Substance Abuse Task Force Chair
Phone: (253) 535-7206
E-mail: gilchrga@plu.edu

PURPOSE AND BENEFITS:
You are invited to participate in an educational research study. The purpose of this study is to assess PLU student thoughts, feelings, and behaviors with substance use. You have been invited to participate because you are a PLU student. Your contribution will help the researchers understand the unique reasons PLU students have for using alcohol and other drugs and hopefully equip the Substance Abuse Task Force to provide relevant prevention programming, updated policies, and increase resources for students.

PROCEDURES:
First by clicking the check box below you provide your consent to participate in the survey. You can print this page for your records. You will then complete a survey which should take approximately 5-10 minutes to complete. When you are done with the survey, you will be provided with the Debriefing form including resources which may be printed for your records as well.

RISKS:
There are limited risks to completing this survey. Although the researcher will make every attempt to protect your confidentiality, there is a remote risk of legal consequences should you admit to participating in illegal behavior. You are encouraged to seek the advice of a professional should it raise any concerns about your physical or mental health. Phone numbers and emails are provided on your debriefing form. If you have any questions about the procedures of this study, bring them to the attention of the administrator, or contact the lead researcher. Your participation in this study is voluntary. If at any time you wish to discontinue, you may do so without penalty.

BENEFITS:
This study will contribute to understanding PLU student motivations to use substances and may also allow you the opportunity to consider your own thoughts, feelings, and behaviors surrounding why you may or may not use substances.

CONFIDENTIALITY
The information in the study records will be kept confidential. Data will be stored securely. The surveys will be stored separately from the consent forms in a secure location. The surveys will be made available only to persons conducting the study unless you specifically give permission in writing to do otherwise. No reference will be made in oral or written reports that could link you to the study or the study summary results which will be published.

CONTACT
If you have questions at any time about the study or the procedures (or you experience adverse effects as a result of participating in this study), you may contact the Lead Researcher: Garrett A. Gilchrist, Ph.D. at 253.535.7206 and gilchrga@plu.edu or Co-Researcher: Jennifer Warwick at warwicjl@plu.edu. If you have questions about your rights as a participant, contact the PLU Human Rights Review Board Chair at hprb@plu.edu.

PARTICIPATION AND ALTERNATIVES TO PARTICIPATION
Your participation in this study is voluntary; you may decline to participate without penalty. If you decide to participate, you may withdraw from the study at anytime without penalty and without loss of benefits to which you are otherwise entitled. If you withdraw from the study before data collection is completed, your data will be returned to you or destroyed.

CONSENT:
Your participation in this survey is voluntary and by checking the answer "Agree" on this form below (question 1), you indicate that you have understood to your satisfaction the information regarding participation in this research project and agree to participate as a subject. In no way does this waive your legal rights nor release the investigators, sponsors, or involved institutions from their legal and professional responsibilities.



YOU CAN PRINT OR SAVE THIS PAGE FOR YOUR RECORDS
*
1. I have read the above information and agree to participate in this study. I can print a copy of this form.
Powered by SurveyMonkey
Check out our sample surveys and create your own now!