ࡱ> GIF] %bjbjjj 0,)b)bg  PPPPPddd8Dd 8($444$$$7777777$#:<7P$@$$$7PP447   $FP4P47 $7  83X54`l-j4x770 84:w=@fw=4X5w=PX5  $$$77f$$$ 8$$$$w=$$$$$$$$$ B : ϳԹ Consent to Participate in Research Introduction. You are invited to participate in a research study entitled add name of study. The purpose of the research is give an explanation of the purposes of the research. Procedures. Give an explanation of the requirements for the study, including: a description of the procedures the subject will follow, the expected duration of each part of the subjects involvement, how many subjects will be participating in the research, if any compensation will be given. Location. The interview/survey/experiment will take place state where the research will take place. If an exact location is not available describe the characteristics of the location/environment). Voluntary Nature of the Study. Your participation in this study is strictly voluntary. If you choose to participate you can change your mind at any time and withdraw from the study. You will not be penalized in any way or lose any benefits to which you would otherwise be entitled if you choose not to participate in this study or to withdraw. Potential Risks and Discomforts. The potential risks of participating in this study are: Provide a description of any reasonably foreseeable risks or discomforts to the subject All risks provided in the IRB application should be listed here. Anticipated Benefits. Anticipated benefits from this study are add the potential benefits to the Navy, science, and possibly the participants. If the subject will not directly benefit, include this statement: You will not directly benefit from your participation in this research. Confidentiality & Privacy Act. Any information that is obtained during this study will be kept confidential to the full extent permitted by law. All efforts, within reason, will be made to keep your personal information in your research record confidential but total confidentiality cannot be guaranteed. [Insert a description of how records and data will be stored and maintained and who will have access. Describe any study specific issues that may increase the risk of breach of confidentiality.] Points of Contact. If you have any questions or comments about the research, or you experience an injury or have questions about any discomforts that you experience while taking part in this study please contact the Principal Investigator, Dr. Joseph Researcher, 656-9999,  HYPERLINK "mailto:jresea@nps.edu" jresea@nps.edu. Questions about your rights as a research subject or any other concerns may be addressed to the Navy Postgraduate School IRB Chair, Dr. Larry Shattuck, 831-656-2473,  HYPERLINK "mailto:lgshattu@nps.edu" lgshattu@nps.edu. Statement of Consent. I have read the information provided above. I have been given the opportunity to ask questions and all the questions have been answered to my satisfaction. I have been provided a copy of this form for my records and I agree to participate in this study. I understand that by agreeing to participate in this research and signing this form, I do not waive any of my legal rights.  I consent to participate in the research.  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