Informed Consent Form

Informed Consent Form

Project Title: The Interaction Between Personality and Exercise in Predicting Perceived Stress

Principle Investigator: Bruce Friedman, PhD,

Co-investigators: Rena “Liz” Courtney, M.A., Patrick Brice, PhD             

Purpose:

This study focuses on the connection between personality, exercise and stress. It is hoped that this study can be used to further our understanding of how exercise and personality factors interact to predict stress.

Procedures:

If you choose to participate in this study, you will be asked to do the following:

1.     Fill out a questionnaire about your demographic information

2.     Fill out a questionnaire about your current stress levels  

3.     Fill out a questionnaire about your current physical activity levels

4.     Fill out a questionnaire about your personality

It is anticipated that your participation will take an approximate total of 1 hour. You will not be directly compensated for your participation. However, at the end of the study you will be given the opportunity to choose between three non-profit organizations. The organization of your choice will receive a donation from the investigator on your behalf.

Language:

I will accommodate your preference for language and communication style. Please let me know about any particular communication requirements that you require.

Risks:

There is no more than minimal risk to individuals who participate in this research study.

Benefits:

Your participation in this study will create a valuable contribution to the literature by extending the work of previous researchers.

Confidentiality:

Data will be kept completely confidential, that is, no one will know anything about your name or any other identifying information as a result of your participation. No identifying information will be collected. However, the IRB reserves the right to review the data from this project for audit purposes.

Voluntary Participation:

Your participation in this study is voluntary. If you decide not to participate in the study, your relationship with Gallaudet University or Virginia Tech will not change in any way. You may withdraw from the study at any time before or during data collection, for any reason and without penalty.

Results:

You will not be given your individual results from any of the questionnaires. However, if you are interested in being contacted with the results of the published study you may contact the primary investigator of this study. 


Contact Information:

Investigators:

            Principal Investigator: Dr. Bruce H. Friedman, Virginia Tech, Dept. of Psychology
                        231-9611   
                        bhfriedm@vt.edu

            Co-Investigator: Rena “Liz” Courtney, Gallaudet University, Dept. of Psychology          
                        202-651-5540
                        personality.exercise.stress@gmail.com

            Co-Investigator: Dr. Patrick Brice, Gallaudet University, Dept. of Psychology
                        202-651-5540
                        Patrick.brice@gallaudet.edu

            Co-Investigator: Alisa Huskey, M.S., Virginia Tech, Dept. of Psychology
                        ahuskey@vt.edu

IRB Contact Information:

            Virginia Tech IRB Chair: Dr. David Moore, Virginia Tech, Dept. of Psychology
                        231-4991    
                        moored@vt.edu

            Virginia Tech Human Subjects Committee Chair: Dr. David Harrison, Dept. of Psychology
                        231-4422
                        dwh@vt.edu

            Gallaudet University IRB Chair: Dr. Steven Collins, Gallaudet University
                        800 Florida Ave NE   
                        Washington DC, 20002
                        irb@gallaudet.edu

* 1. Intent to Participate:

I have read the Informed Consent Form and agree to participate in the study conducted by Rena Courtney at Gallaudet University. I understand that I can withdraw from this study at any time without penalty or prejudice. I understand that I will not receive direct payment or reimbursement for my participation but will choose an organization who will receive a donation on my behalf.

Report a problem

T