A Questionnaire-Based Study Consent Forms
|Participant Consent Form||November 2004 Colorado State University|
Community Based Writing Journals: Guiding Principles and Practices
This form is an agreement to participate in a research study. I am interesting in gaining insight into the guiding practices and principles of community based writing journals so that I can develop a plan to work with members of my community in writing journal projects for my thesis work. As the editor of The Journal of Ordinary Thought, you can be of great help providing information about the ways in which the journal has developed. I would like to correspond with you so that I can better understand principles that guide The Journal of Ordinary Thought’s approach to community writing and publishing.
- To participate, you are asked to respond to a questionnaire that inquires about the guiding principles and practices of The Journal of Ordinary Thought. Responding to this questionnaire will take one or two hours of your time.
- After replying to the questionnaire, you will also be asked to respond to a few follow-up questions. These responses will take about ½ hour of your time.
- In all correspondence for this research study, you may choose whether or not to respond to each question individually and you may opt to skip any question that asks you to reveal information you do not wish to reveal.
- You can reply to the questionnaire by handwriting on the questionnaire or by typing responses and attaching a printed copy, or you can elect to have the questionnaire sent to you electronically via email and can respond electronically.
Please be aware that, as a participant in this research, your identity will not be kept confidential. Since the names of the editors are listed on the editorial staff page of each edition of The Journal of Ordinary Thought, I do not plan to omit or change your name as I review your responses and write my thesis. Keep in mind, however, that responding to each question on the questionnaire is optional, so you should not feel obliged to reveal any information that you may want to keep confidential.
There are no direct risks or benefits to participating in this study. It is not possible to identify all potential risks in research procedures, but the researcher(s) have taken reasonable safeguards to minimize any known and potential, but unknown, risks. While there are no direct benefits to you, I hope that engaging in correspondence about The Journal of Ordinary Thought will be beneficial to both of us as it may result in widening the network of writers and editors interested in understanding and promoting community based writing journal projects
Your participation in this research is voluntary. If you decide to participate in the study, you may withdraw your consent and stop participating at any time. Keep in mind, also, that in all correspondence for this research study, you may choose whether or not to respond to each question individually and you may opt to skip any question that asks you to reveal information you do not wish to reveal. The Colorado Governmental Immunity Act determines and may limit Colorado State University's legal responsibility if an injury happens because of this study. Claims against the University must be filed within 180 days of the injury.
Page 1 of 2 Participant’s initials _________ Date ________________
Before you decide whether or not to engage in correspondence about the guiding practices and principles of The Journal of Ordinary Thought, please contact me with any questions at 970-221-1521 or email@example.com. If you have additional questions, please contact Tobi Jacobi, who is my faculty advisor and the principal investigator for this research. If you have any questions about your rights as a volunteer in this research, contact Celia Walker, Director of Regulatory Compliance, at 970-491-1553.
I look forward to learning more from you.
Renee Rallo, Colorado State University
Your signature acknowledges that you have read the information stated and willingly sign this consent form. Your signature also acknowledges that you have received, on the date signed, a copy of this document containing two pages. Please initial and date the bottom of each page.
Please check one:
___ I would like to participate and would like to receive and respond to the questionnaire by postal mail.
___ I would like to participate and would like to receive and respond to the questionnaire electronically through email.
|Participant name (printed)|
If you do not wish to participate, please check the following box:
___I do not wish to participate in correspondence for this research.
Page 2 of 2 Participant’s initials _________ Date ________________