Table C–2

Sample Informed-Consent Form

Studentstaking PSY 455, Research Design, are investigating the effects of noise andsleep deprivation on anxiety.

If you participate in and complete this study, theinvestigators will interrupt your sleep for one hour on two consecutive nights.During that hour, you will be woken up, asked to fill out two questionnaires, and your pulse and bloodpressure will be measured several times.

You will be asked to spend two nights in a specialdorm room so that your sleep can be monitored. In addition, it will takeapproximately 60 minutes each night for the blood pressure and questionnairemeasures to be completed.

You will receive $20 for participating in the study.

Physical injury, psychological injury, or deceptionare not part of this study. In addition, all your responses and answers will beheld confidential. No one other than the investigators will see informationabout your particular responses.

Any questions you have regarding this project shouldbe addressed to the investigators or to Dr. ________________, facultysupervisor (phone:           ,e-mail: ).

If you agree to participate in this study, pleasesign the following statement.

I have read the above Consent Form and understandthe proposed project. I consent to participate in this study. I understand thatI can quit the study at any time. Finally, I will be paid $20 whether or not Icomplete the study.

 

Signature                                                      Date

 

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