Informed Consent Form

#Insert the Title of your Study Here

University of Wisconsin-Madison

Department of Communication Arts

PURPOSE OF THIS STUDY:

The purpose of this study is to investigate # finish this sentence.

BENEFITS OF THE STUDY:

The research may benefit the participants by offering them the opportunity to reflect on their own #finish this sentence. Further, the research is largely sympathetic to the position of the participants, so they may gain some satisfaction from seeing their beliefs documented in academic research.

The research will benefit society in two ways. First it will document #finish this sentence. Second, the study will increase our understanding of #finish this sentence.

NATURE OF THIS STUDY:

Participation in this study is voluntary. Participants may decline to participate or may withdraw from the study at any time with no penalties.

In signing this informed consent statement, you agree to participate in a 30 to 45 minute voluntary interview in which the study team will ask you to describe your beliefs about and experiences with #finish this sentence. You understand that what you say may be quoted in scholarly publications, research presentations, and/or class room materials.

RISKS OF THIS STUDY:

Participation in the study involves minimal risks, and the researchers have taken precautions to minimize these risks. Personal names will not be used in any published results or course materials unless requested by the participant.

I HAVE READ THE ABOVE STATEMENT AND UNDERSTAND ALL THE RISKS ASSOCIATED WITH PARTICIPATION IN THIS STUDY. I AGREE TO PARTICIPATE IN THIS STUDY.

____________________________________ (signature) _________________ Date

____________________________________ (print name)

Study Inteviewer

#insert your name

The Interviewee should be left with copy of this form. If question s arise that the interviewer cannot answer, please contact :

Principle Investigator

Robert Glenn Howard, Ph.D.

Department of Communication Arts & Communication Technologies Research Cluster

University of Wisconsin-Madison

rgh[NOSPAM]rghoward.com

1-608-347-1520

http://rgh[NOSPAM]rghoward.com