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Sample Letter of Consent for Adults

[for studies that would not exceed minimal risk]

Dear _________________.

I am a professor [a graduate student under the direction of Professor ________] in the Department/Division/College of __________________ Southern Methodist University. I am conducting a research study to _____(state purpose of study) ________________.

Your participation will involve ______________________. (Explain the procedures and include the expected duration of the subject's participation). Your participation in this study is voluntary. If you choose not to participate or to withdraw from the study at any time, there will be no penalty, (it will not affect your grade, treatment/care, select whichever applies). The results of the research study may be published, but your name will not be used.

IMPORTANT NOTE: Recent federal (and state) laws may compromise the presumed confidentiality of your data. Therefore, it is important to include a phrase such as "to the extent allowed by law" in all consent forms in the section concerned with confidentiality for subjects. For instance, in your Letter of Consent, you ought to include a phrase such as this: "Information obtained during the course of the study will remain confidential, to the extent allowed by law."

There are foreseeable risks or discomforts to me if I agree to participate in the study. The possible risks are . . . Possible discomforts include . . .[Any foreseeable risks or discomforts are to be explained/described] OR There are no foreseeable risks or discomforts if I agree to participate in this study.

Although there may be no direct benefit to you, the possible benefit of your participation is _______________________________________________.

If you have any questions concerning this research study, please call [name and position _______________ at (***) ***-**** or [e-mail address, if available].

Sincerely,

[researcher's name]

* * * * * * *

I give my consent to participate in the above study. (Release statement for videotaping or relinquishing confidentiality must be inserted here, if applicable).

_______________________________ (signature) _______________________ (date)

[OPTIONAL: Inclusion of the following is optional]:

If you have any questions about your rights as a subject/participant in this research, or if you feel you have been placed at risk, you can contact the Chair of the Institutional Review Board (Human Subjects Research Committee).