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MOUNT HOLYOKE COLLEGE
INFORMED CONSENT FORM (ORAL)

Title of Study:	
Investigator(s):
Brief description of project and procedures to be followed:	

This project has been approved by the Institutional Review Board of Mount Holyoke College. Informed consent is required by Mount Holyoke College for all participants in human subjects research.  

  	A.  Your participation is voluntary. 
 
B.  You  may withdraw your consent and discontinue participation in this study at any time.  You will not be penalized in any way if you decide not  to participate.

C. The procedures to be followed in the project will be explained to you, and any questions you may have about the aims or methods of the project will be answered.  

D.  All of the information from this study will be treated as strictly confidential.  No names will be associated with the data in any way.  If you provide your address in order to receive a report of this research upon its completion, that information will not be used to identify you in the data.  The data will be stored in locked offices in ________________ and the data will be accessible only to  the investigator(s).

E.  The results of this study will be made part of a final research report and may be used in papers submitted for publication or presented at professional conferences, but under no circumstances will your name or other identifying characteristics be included.

If you understand the above, and agree to participate in the project, your name will be recorded below to acknowledge your consent:

					   	______ 			__________________
(Researcher to record participant name here)			            (date)

If you have any questions about this research, contact ___________________ (the investigator) at ________________ or Mount Holyoke College’s Institutional Review Board, at institutional-review-board@mtholyoke.edu.

Would you like a report on the group results of this research project upon its completion?

YES						NO
Address to which the report should be sent: