| OFFICE OF RESEARCH INTEGRITY |
Several health and welfare conditions must be met from the IACUC perspective:
Other procedures/requirements
SAMPLE
PURPOSE OF STUDY :
PURPOSE OF THE FORM:
You are being asked to give your consent to have your (type of animal) participate in a research study. This consent form gives you the information you will need to help you decide whether to allow your animal to participate. Please read the form carefully. You may ask any questions about the research, the possible risks and benefits, rights as a volunteer participant, and anything else that is not clear. When all of your questions have been answered, you can decide if you will allow your animal to be in this study or not.
WHAT WILL HAPPEN IN THE STUDY:
RISKS OF THE STUDY:
BENEFITS OF THE STUDY:
IS THERE COMPENSATION FOR PARTICPATING:
ARE THERE ANY COSTS FOR PARTICIPATING:
IN CASE OF INJURY:
WITHDRAWING MY ANIMAL FROM THE STUDY:
Your participation in this study is entirely voluntary and you may withdraw your animal at any time. You also understand that your animal may be withdrawn from the study if the investigators find it necessary. If your animal is withdrawn from the study for any reason, data already collected may continue to be used for research purposes.
You will not be treated differently if you decide to not participate in this study. Your decision to participate, not participate, or withdraw from the study will not affect your relationship with OSU.
WHAT IF I HAVE QUESTIONS?
If you have any questions about the study, you may contact Dr. XXXX at XXX-XXXX.
Your signature indicates that this research study has been explained to you, that your questions have been answered and that you agree to allow your animal to be in the study. You will receive a copy of this form.
Animal’s Name:_______________________________
Owner’s Printed Name:_____________________________
Owner’s Signature: _________________________________ Date:____________
Principal Investigator’s Printed Name:_________________________________
Principal Investigator’s Signature: _______________________________ Date: ____________
Accepted by the IACUC: 10-3-06