* 1. Influenza Vaccination Research Consent Document

This study examines vaccination behavior for the influenza (flu) virus in college students. It also examines the effects of a number of variables on vaccination behavior, including intentions to be vaccinated, attitudes toward vaccination, amount of control over being vaccinated, other health behavior habits and mindfulness, or moment by moment awareness.

I understand that if I participate, I will complete several questionnaires concerning my past and current vaccination behavior and my attitudes toward vaccination. These questionnaires will take about 30 minutes to complete.

Additionally, I give my permission to be contacted one time, within six months, via the e-mail address or text message number provided at the end of the survey for a brief follow-up regarding flu vaccine attainment (one yes/no question). I understand that my information will be kept secure and deleted upon my completion of the study.

I understand that my participation is completely voluntary and that I may stop or withdraw at any time. I understand that this research provides no benefits to me. There is no risk involved in participating in this study other than any discomfort I might feel in thinking about some of the questions I am asked. I also understand that I will be entered into a drawing for a $200.00 cash prize (one winner) for my participation in the study, and that I will be contacted via the e-mail address or phone number provided if I win the drawing. If I am enrolled in an undergraduate psychology course that provides extra credit for research participation, I can choose extra credit instead of being entered into the drawing for the cash prize.

If at any time I have any questions or comments about the study I can contact the researchers, Melissa Mattson, at 651-497-9634 or mmattso1@hawk.iit.edu, Michael Young, Ph.D., at 312-567-3503, or Glenn Krell, Executive Officer of the IIT Institutional Review Board, at 312-567-7141.

I understand that the Illinois Institute of Technology is not responsible for any injuries or medical conditions I may suffer during the time I am a research subject unless those injuries or medical conditions are due to IIT’s negligence. I may address questions and complaints to Glenn Krell MPA, CRA, Executive Officer of IIT Institutional Review Board at (312) 567-7141.

I have read the material above and I understand that completing the questionnaires indicates that I agree to participate in this study.