Informed consent example

Informed consent

The experiment in which you are about to participate investigates the presentation of words or letters at a given rate, and your ability to distinguish these words or letters. The experiment is being conducted by Hugh D’Experimenteur and Milo Budjette, psychology students under the supervision of Dr. Profsname, assistant professor of psychology, and has been approved by the Human Subjects Committee at SUNY Oswego.

The experiment is run on a screen, where you will be asked to look at a sequence of words or letters, and make a simple verbal response of what you saw. For example, if you were presented with a sentence one word at a time, you would be asked to repeat the sentence just as you saw it. Or, you may be asked to report the color that the word was presented in. There are no hazards or risks involved, with the exception of possible eye strain or headache.

The experiment will last about 15 minutes.

Each person’s data in this study will be confidential. Your name will not be reported, and the data that will be reported will be the average time for all participants in each condition. At the end of the study, a full explanation of the experiment will be given to you.

By participating in this study, you will increase your understanding of psychological research, and the results will help increase understanding of how we learn information.

Your participation is voluntary, and you are free to discontinue participation at any time without penalty.

If you have any questions about the experiment, please contact Hugh D’Esperimenteur at 315.555.5555, or Dr. Profsname at 315.555.7763. If you have any questions about your rights as a research participant, please contact Dr. Bozak, chair of the Human Subjects Committee (

I have read the above statement about the purpose and nature of the study, and I freely consent to participate.

Participant’s Signature              Date          Experimenter’s Signature                      Date

Print Participants Name                              Print Experimenter’s Name

The experimenter should give a copy to the subject and keep a signed copy.