1. Consent Form

 
11% of survey complete.
Introduction:
You are invited to be in a research study about college students with a history of brain injury and about students who have been hospitalized during college because of illness or injury. Your participation as someone who was hospitalized while in college allows us to compare experiences across groups of individuals. We ask that you read this page and ask any questions you may have before agreeing to be in the study.

This study is being conducted by Dr. Mary Kennedy, Associate Professor in the Department of Speech-Language-Hearing Sciences at the University of Minnesota, Twin Cities.

Study Purpose:
The purpose of this survey is to learn about the how the needs of students with brain injury compare to those of students without brain injury and those who have been hospitalized (for illness, injury), what resources are or were used by students, and whether existing resources are meeting or did meet students' needs.

Study Procedures:
If you agree to be in this study, we would ask you to answer the survey questions on the following pages. You can navigate through the survey using forward and backward arrow buttons.

Benefits of Study Participation:
While the information gained from this project will help us in understanding how brain injury affects students’ lives, there are no direct benefits to you from your participation.

Risks of Study Participation:
The only risks associated with taking a survey are feeling tired and/or irritated with the survey questions. Your participation in the survey is voluntary, and you can take a break or stop at any time you wish.

Survey Costs/Compensation:
You will not incur any costs associated with participating in this study.

After completing the survey, all participants will be entered into a drawing for a $30 gift certificate to Amazon.com. One winner will be chosen randomly from every 30 participants; you will be notified by e-mail if you win the drawing.

Confidentiality:
The records of this study will be kept private. In any publications or presentations, we will not include any information that will make it possible to identify a subject. Your responses to the survey may, however, be reviewed by the researchers associated with this study.

Your participation in the survey will be kept confidential by the study team. No information that identifies you will be released to parties outside of the research team, except as required by law. All reasonable efforts will be utilized to safeguard all identifiable information. Data from this study will be kept on file for three years.

Voluntary Nature of the Study:
Participation in this study is voluntary. Your decision whether or not to participate will not affect your current or future relations with the University of Minnesota, the University of Minnesota's Disability Services, or any other organization. If you decide to participate, you are free to withdraw at any time with out affecting those relationships.

Contacts and Questions:
The researcher conducting this study is Dr. Mary Kennedy, Ph.D. If you have any questions, *you are encouraged* to contact Dr. Kennedy before or after completing the survey. She may be reached at 115 Shevlin Hall, 164 Pillsbury Dr. S.E., Minneapolis, MN, 55455: (PH) 612-626-9688; (Email) kenne047@umn.edu.

If you have any questions or concerns regarding this study and would like to talk to someone other than the researcher(s), you are encouraged to contact the Research Subjects’ Advocate Line, D528 Mayo, 420 Delaware St. Southeast, Minneapolis, Minnesota 55455; (612) 625-1650.

You may print a copy of this page to keep for your records.

[IRB#0801S24963, consent version 12/03/08]

T