ࡱ> ;=:[ bjbj** :.HbHb  8Dn,,,,,=??????$,!cc,,x:,,==,Ћg"A)0"p""Dcci|" B N:  IRB CONSENT FORM TEMPLATE: Please substitute the boldfaced sections with simple, clear, and grammatical English. All elements must be included but should be modified in language and content appropriate to your research and your subjects. To Project Participant: You are invited to take part in a research project entitled, [Project Title], conducted by [name of Principal Investigator and Institutional affiliation, e.g., Joan Smith at ֱ All Rights Reserved (ֱ)]. In this study we hope to learn more about [subject of study]. You were selected to participate in this study [explain selection process]. We hope that our research will lead to [reasonably expected benefits to subject or others]. [Describe what the subject will be expected to do. State the duration of the subject's participation. If there is to be any compensation, state the compensation.] [Describe the risks involved, discomforts, or inconveniences. If a potential risk is a loss of confidentiality, you must explicitly say so. If psychological and/or physical risks are involved, these must also be explicitly communicated. Should participation in this research project result in an adverse event, an enrolled/eligible student may seek basic mental health care within the scope of the services of the staff of the Student Counseling Center, during normal operating hours, or see a personal/outside health care provider for care and treatment. For care beyond the scope of services at ֱ, such as physical injury or illness, subjects must seek care and treatment from an outside/personal health care provider. In all cases, in the event of need for emergency medical care, call 911. Any and all incurred health care costs associated with participation in this research project are the responsibility of the subject. If a medical or mental health treatment is involved in this research project, and as a consequence the subject wishes to withdraw from the study, briefly describe alternative interventions.] Reports resulting from this study will not identify you as a participant. All information gathered in this study will remain confidential and be given out only with your written permission or as required by law. [Briefly explain the method of confidentiality, e.g. by numbered cross-references or by keeping the files locked up. Consent forms, audio/videotapes, numbered cross-references and data should be kept in separate locked locations. Indicate how long files will be kept before being destroyed; the minimum requirement is three years following completion of the study. If the Principal Investigator is a student, files must be kept in the advisors or other department office, although anonymous data files may be used at the students home during the project period. Explain exceptions to the protection of confidentiality, where applicable. For example, under Massachusetts law we are obligated to report any abuse that we encounter or reasonably suspect regarding children and the elderly. This mandate also applies to expressed intent to commit harm to another that we encounter or reasonably suspect.] If you have any questions about this research at any time, please contact [Principal Investigator] at [phone number, email address and street address. Also list any other appropriate names and contact information, e.g., Faculty Supervisor and/or Other Investigator(s).] By signing this consent form you indicate that you have read the form and agree voluntarily to participate in the study. If you choose not to take part, there will be no penalty or loss of benefits to which you are entitled. If you agree to take part, you are free to withdraw from it at any time. Likewise, no penalty or loss of benefits to which you are otherwise entitled will occur. I agree to participate in [Project Title], as set out above. ____________________________ _________________ Signature Date THIS PROJECT HAS BEEN REVIEWED BY THE BERKSHIRE COMMUNITY COLLEGE INSTITUTIONAL REVIEW BOARD FOR THE PROTECTION OF HUMAN SUBJECTS IN RESEARCH. ADDITIONAL CONCERNS AND COMPLAINTS, OR QUESTIONS REGARDING YOUR RIGHTS AS A RESEARCH PARTICIPANT, SHOULD BE DIRECTED TO THE IRB CHAIR, MARGARET STEPHENSON, AT 413-236-2117.     0GK> H I R V Y g o teXHt8hF]hW5CJOJQJ^JhF]h5CJOJQJ^JhZ5CJOJQJ^JhF]hCJOJQJ^JhCJOJQJ^JhF]hWCJOJQJ^JhQIhT6CJOJQJ^JhQIhW6CJOJQJ^J"hQIhrM56CJOJQJ^J"hQIhW56CJOJQJ^J"hQIh5jZ56CJOJQJ^Jh5CJOJQJ^Jh5jZ5CJOJQJ^J k l 45DE8KL $<<a$gd[ $ *$a$ $ *$a$gd5jZo x y  M f  C O h j l m z  Ȼ՟՟՟՟~~~ՐՐ~qd~dh 5CJOJQJ^Jh5CJOJQJ^J"hIfOhW5>*CJOJQJ^Jh24ⱋ~q~~~~V+䴳ϴ*CJOJQJ^JhF]hO H5CJOJQJ^JhF]hW5CJOJQJ^Jh)l55CJOJQJ^J! #%,ADEL]Ữᔡyl\Mh?hYVCJOJQJ^JhF]h$5CJOJQJ^Jh$5CJOJQJ^Jh* CJOJQJ^JhO HhWCJOJQJ^JhV5CJOJQJ^JhK5CJOJQJ^JhL5CJOJQJ^Jhxr5CJOJQJ^Jh+KCJOJQJ^Jh+K5CJOJQJ^JhF]hW5CJOJQJ^JhF]hWCJOJQJ^J]SVϿh3hjh3hU"h[hWCJOJQJ\]^Jh[B*CJOJQJ^Jph%hThYVB*CJOJQJ^Jphh?hYVCJOJQJ^Jh?h?CJOJQJ^J $<<a$gd[ 800P/ =!`"`#@$% Dps02 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH <`< NormalCJ_HmH sH tH DA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List PB@P Body Text$ *$a$OJQJtH uHH (+ Balloon TextCJOJQJ^JaJB' B wComment ReferenceCJaJ8"8 w Comment TextCJ:1: wComment Text CharLj!"L wComment Subject5\mHsHtHF/QF wComment Subject Char5\4b4 DHeader  H$2/q2 D Header CharCJ4 4 D0Footer  H$2/2 D0 Footer CharCJ.X . [Emphasis6]PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vc:E3v@P~Ds |w< . o B] 8@0(  B S  ?5Ydta o ] f ] a &L=O33333333333333nn'h1&VLl * $J3UD_FkGO HQIN4IIfOuS!TYVWfWLkWXGX5jZF]"^]nabK)m3E] 1sWq8 V-GI9.{wT{7&?+KZrM5-V~;S3!=BWvUKDmPIP`w{&\I1Table"WordDocument:.SummaryInformation(*DocumentSummaryInformation82CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q