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Consent Form

Purpose: This consent form is a request for your participation in a research study by Sherene Woolcock, a doctoral candidate at Trevecca Nazarene University.  This research is being conducted under the supervision of Dr. Edward Piatt. The purpose of this study is to gather information from individuals with Diabetes and gain insight on their understanding of their disease process.  

Voluntary Participation: Your participation in this study is voluntary.  Moreover, you may discontinue participation at any time and for any reason without negative consequences by contacting the researcher using the contact information below.

Explanation of Procedures: You will be asked to complete a survey regarding Diabetes. The survey will take approximately 20 minutes to complete.

Confidentiality: You will be asked to provide a signature at the bottom of this page signifying that you understand the information contained in this consent form.  The researcher will keep this document separate from your completed survey such that there will be no way to connect survey responses with individual respondents.  Moreover, minimal demographic and identifying information will be collected in order to help preserve your privacy

Completed surveys and the signed consent forms will be kept in a locked filing cabinet in the researcher’s office.  After collection, survey data is often entered into a password-protected Excel file and stored on a private password-protected computer to which only the researcher has access.

Discomforts and Risks: Risks from participation in this study are minimal.  One potential risk is an accidental breach of confidentiality.  As outlined above, various steps will be taken to maintain confidentiality.

Expected Benefits: There are no anticipated benefits from participating in this research other than contributing to the advancement of scientific knowledge. 

Use of Research Data: The information from this research will be used only for scientific and educational purposes.  It may be presented at scientific meetings and/or published in professional journals or books, or used for any other purposes, which Trevecca Nazarene University considers proper in the interest of education, knowledge, or research.  As noted earlier, data will be analyzed and presented in the aggregate such that all individual responses will be kept confidential.

Approval of Research: This research project has been approved by the Institutional Review Board at Trevecca Nazarene University.

Liability/Limitations: Trevecca Nazarene University, its agents, trustees, administrators, faculty, and staff are released from all claims, damages, or suit, not limited to those based upon or related to any adverse effect upon which may arise during or develop in the future as a result of participation in this research.  Please understand that this release of liability is binding upon you, your heirs, executors, administrators, personal representatives, and anyone else who might make a claim through or under you.
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