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 CONSENT FORM

Dr. David Dickinson is screening potential subjects for a funded research study in the general area of sleep and decisions.  His specific need is for young adult subjects between 18 and 39 years of age.  This screening survey requires you to provide certain demographic information and information on mood.  If you are selected, you become eligible for participation in future cash-compensated research experiments.  Please note that you must complete the entire questionnaire to be eligible for selection.  The estimated time to complete this questionnaire is about 6 minutes.  Completion of this questionnaire does not guarantee your selection and participation in a future experiment, it only provides the researchers authorization to place your e-mail address in a recruitment pool for future consideration.  If selected, you will be contacted at a future date.  You are free to withdraw at any point without penalty or loss of benefits to which you are entitled.

The information you provide in the questionnaire WILL REMAIN CONFIDENTIAL.  Only those researchers associated with the study will have access to your personal information.  Your name and associated personal information will not be shared with anyone outside of the research team and will be kept in password-protected files.  You may wish to contact your health care provider or ASU counseling (at x3180--for those affiliated with ASU) if you endorse a number of sleep or mood related symptoms on the survey and experience distress related to them.

For additional information related to this questionnaire, contact Dr. David Dickinson, Department of Economics, Appalachian State University, at dickinsondl@appstate.edu.  
Questions regarding the protection of human subjects may be addressed to the IRB Administrator, Research Protections, Appalachian State University, Boone, NC 28608 (828) 262-2692, irb@appstate.edu

This research project has been approved on March 3, 2017, by the Institutional Review Board (IRB) at Appalachian State University.  This approval will expire on March 2, 2018, unless the IRB renews the approval of this research.

Do you understand and accept the terms and conditions listed above, are at least 18 years old, and wish to be considered as a potential subject for future studies?

 

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