CONSENT FORM FOR ONLINE SURVEYS Campus Climate and Gay, Lesbian, Bisexual and Transgender Students at Lock Haven University
Primary Investigator(s): Dr. Frederick “Rick” Schulze; Dr. Tara Mitchell; Dr. Erin Kennedy Address: Room 116 Health Professions Building Phone and E-mail: x2155; email@example.com
We invite you to participate in a study of campus climate at Lock Haven University regarding students who are gay, lesbian, bisexual or transgender. University students who are gay, lesbian, bisexual, or transgender may experience challenges on campus because of how others perceive and treat them as a result of their sexual orientation, gender identity, or gender expression. You have been selected for this study because you are a student, faculty, or staff member at Lock Haven University. This study will provide useful information and recommendations for Lock Haven University related to concerns in the area of gay, lesbian, bisexual, and transgender students.
Investigational Procedures If you choose to participate in this study, you will indicate your willingness by clicking below on the link to the online survey. The survey that you will complete consists of 22 questions about campus climate issues regarding gay, lesbian, bisexual, and transgender students. It is estimated the questionnaire will take you 10-15 minutes to complete depending upon your responses. One sample question is:
Have you heard a negative remark about gay, lesbian or bisexual students made by another Lock Haven University student?
Risks and Benefits This investigational procedure does not pose any more risk than you experience in daily living. If you participate in this study, you can assist Lock Haven University in addressing the concerns of gay, lesbian, bisexual, and transgender students. You might experience the satisfaction that comes with research and discovery. We appreciate your assistance in our research effort and hope you will find the experience rewarding. We do not promise, however, that you will receive any of these benefits.
Privacy of Records Your data record is totally anonymous. All the information you provide will be used responsibly and will be protected against release to unauthorized persons.
By clicking on the survey link below and by submitting a completed survey, you are giving permission to use your data record in this study. The results of this study may be published in health education journals and presented at conferences such as the American School Health Association Meeting and American Public Health Association Annual Meeting, but no publication or presentation will contain information that will identify you.
Payment You will receive no payment or compensation of any kind for participating in this study.
Conclusion Your decision whether or not to participate in this study is voluntary and will not affect your standing at Lock Haven University.
Even if you decide to participate now, you may stop at any time and close your browser. You are making a decision whether or not you will participate in this study. If you click on the link below and submit a completed survey, you are indicating your agreement to participate based on reading and understanding this form. If you have questions, please contact the investigator identified at the top of this form prior to completing the survey.
If you have any questions regarding your rights as a research participant, please contact Dr. Christine Offutt, Chairperson, Lock Haven University Institutional Review Board for the Protection of Human Subjects (IRB-PHS) at firstname.lastname@example.org or (570) 484-2400.
Based on the information above, I agree to participate in this study and verify that you are 18 years of age or older. Continue to the survey by clicking the button below.
If you do not wish to participate in this study, please either delete this email or close the browser.