Research purpose or issue:
Population to be studied: Gender M Age 26 Race/ethnicity Asian
Number of groups and number of participants in each group:
Inclusion and exclusion criteria:
How Subjects will be recruited:
Describe the procedures that the participants will undergo in the proposed research project
to include the physical location and duration of subject participation (attach a copy of all research instruments e.g., surveys, questionnaires, interview questions etc.):
Describe procedures that will be used to maintain confidentiality, including plans for storing/disposing of tapes and other data records at the conclusion of the research:
Research Protocol Please answer yes or no to all questions below.
Does this research involve:
prisoners, probationers, pregnant women, fetuses, the seriously ill or mentally
or cognitively compromised adults, or minors (under 18 yrs) as participants
the collection of information regarding sensitive aspects of the participants
behavior (e.g., drug, or alcohol use, illegal conduct, sexual behavior
the collection or recording of behavior which, if known outside the research,
could place the participants at risk of criminal or civil liability or could be damaging to the participant’s financial standing, employability, insurability,
procedures to be employed that present more than minimal risk* to
deception or coercion
benefits or compensation to participants
a conflict of interest (e.g., teacher/student, employer/employee:
is there any financial interest in this research)
If you answered NO to all of the questions please proceed to the next page.
If you answered YES to any of the questions your proposal must clearly indicate why the use of participants in any of these categories is scientifically necessary and what safeguards will be employed to preserve the participants anonymity/confidentiality. The proposal must identify all risks (physical, psychological, financial, social, other) connected to the proposed procedures, indicate clearly how such risks to participants are reasonable in relation to anticipated benefits, describe methods to protect or minimize such risks, and access their likely effectiveness. Consent/assent forms must be included for research involving minors.
YES NO Is a consent form included with this study? If so, attach a copy.
YES NO Are child assent forms included with this study? If so, attach a copy.
Minors must provide an affirmative consent to participate by signing a simplified form,
unless the principal investigator can provide evidence that the minors are not capable
of assenting because of age, maturity, psychological state, or other factors.
Who is obtaining consent? Check all that apply:
Principal Investigator Research Assistant Other (specify)
How is consent being obtained?
What steps are being taken to determine that potential subjects are competent to participate in the decision-making process?