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P r o t o c o l T i t l e : F O R M T E X T
P r o t o c o l # : F O R M T E X T
C o n s e n t P r o c e d u r e s : I n f o r m a t i o n t o b e p r o v i d e d t o P r o s p e c t i v e R e s e a r c h P a r t i c i p a n t s w h o d o n o t r e a d E n g l i s h .
C O N S E N T FORM FOR PERSONS WHO DO NOT READ ENGLISH
You are being asked to participate in a research study.
Before you agree to take part in the research, you must be told about:
why the study is being done;
what you will be asked to do during the research and any exams, tests, or activities that will be performed during the research;
whether any exams, tests, or activities in the research are experimental;
how long the research will last;
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any other procedures or treatments that might benefit you;
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When it applies to the research, the investigator must also tell you about:
whether medical treatment or payment is available if you have an injury that occurs as a result of the research;
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reasons why the researcher may stop your participation in the research;
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If you agree to take part in the research study, you must be given a signed copy of this document and a written summary of the research.
You may contact FORMTEXT a t p h o n e n u m b e r F O R M T E X T a n y t i m e y o u h a v e q u e s t i o n s a b o u t t h e r e s e a r c h o r i f y o u a r e i n j u r e d d u r i n g t h e r e s e a r c h .
I f y o u h a v e q u e s t i o n s r e g a r d i n g y o u r r i g h t s a s a r e s e a r c h s u b j e c t , y o u m a y c o n t a c t H Y P E R L I N K " m a i l t o : l v a z q 1 @ u i s . e d u " Dr. Luca Vzquez at (217) 206-8112.
Your participation in this research is voluntary, and you will not be penalized or lose benefits if you refuse to take part or decide to stop.
Signing this document means that the research study, including the above information, has been explained to you orally in a language that you understand, and that you voluntarily agree to take part.
FORMTEXT _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ F O R M T E X T _ _ _ _ _ _ _ _
S i g n a t u r e o f S u b j e c t D a t e
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P r i n t e d N a m e
F o r m a n d c o n s e n t s h o u l d b e t r a n s l a t e d i n t o t h e n a t i v e l a n g u a g e of the subject.
University of Illinois
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E-mail: HYPERLINK "mailto:ora@uis.edu" ora@uis.edu Web: HYPERLINK "/research" /research
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