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Researcher’s Copy
I understand that I am being asked to participate in a series of three interviews on my involvement in a service-learning program as part of a study conducted by Drew Stelljes, a doctoral candidate. I further understand that confidentiality will be preserved and that my name will not be associated with any results of this study.
I know that I may refuse to respond to any question asked and that I may discontinue participation at any time without penalty or prejudice. I further understand that my anonymity will be preserved and that my name will not be associated with any results of this study.
This project was found to comply with appropriate ethical standards and was exempted from the need for formal review by the College of William and Mary Protection of Human Subjects Committee on January 13, 2006, and expires on December 31, 2006. I am aware that I may report dissatisfactions with any aspect of this experiment to the Chair of the Protection of Human Subjects Committee, Dr. Michael Deschenes, 757-221-2778 or mrdesc@wm.edu. I am aware that I must be at least 18 years of age to participate. My signature below signifies my voluntary participation in this project and that I have received a copy of this consent form.
Date Signature
Print Name
PLEASE RETAIN THE TOP COPY AND GIVE THE BOTTOM SIGNED COPY TO THE RESEARCHER.