Title: IRB-02
Author: paulsenj
Last saved by: Katrina Ashley Korb
Company: University of Iowa

DEPARTMENT OF EDUCATIONAL FOUNDATIONS
UNIVERSITY OF JOS
Interview Information and Consent Form

Project Title:	Effects of Maltina on Academic Achievement
Research Team:	Katrina A. Korb, PhD
	A.B. Sunday
	C.D. Monday
	E.F. Grace
	
DESCRIPTION OF THE RESEARCH

You are invited to participate in a research study that examines the effects of Maltina on academic achievement. You are invited to participate in this research because you are a 100-level education student at the University of Jos. We are interested in how drinking a Maltina before studying influences your academic achievement. Approximately 40 people will participate in this study. The research is being conducted through the University of Jos.

WHAT WILL MY PARTICIPATION INVOLVE?

If you agree to take part in this study, we will randomly assign you to either a treatment group or a control group. Both groups will take part in the same one-week course on effective study skills. This course will last two hours per day for five days. Participants in the treatment group will be given a Maltina to drink immediately before each lecture while participants in the control group will be given a bottle of Swan water. At the end of the course, both groups will take an exam on what they have learned in the study skills course. 

After you have taken the exam, you may also complete a short interview with a researcher about your participation. This interview will last about fifteen minutes. If you agree, I may audio record our conversation. The audio will be written word-for-word in a computer transcript, but only the above-listed researchers will have access to the entire transcript. When we write the report of this study, we may use short quotes from your interview. However, we will use a different name (a pseudonym) in the transcript to protect your confidentiality unless you sign agreement to use your actual name.

Taking part in this research study is completely voluntary.  You may choose not to take part at all.  If you decide to be in this study, you may stop your participation at any time.  If you do not feel comfortable answering any question in the interview, you are free to tell me so. I will not force you to answer any question that you feel uncomfortable with.
 
WHAT ARE THE RISKS AND BENEFITS OF PARTICIPATING?

We do not expect any direct benefits to you from participating in this study. However, we hope that the information you provide will help scholars and educators have a better understanding of how drinking a Maltina may influence academic achievement. If you agree to allow us to use your name in our reports, you will face the same risks as you would face in being interviewed by a journalist for a newspaper. Such publicity could lead to stigma from people who disagree with your opinion. However, if we use a different name, there are no foreseeable risks for participating in this study.

HOW WILL MY CONFIDENTIALITY BE PROTECTED?

We will keep your participation in this research study confidential. To help protect your confidentiality, your name will only be written on this consent form. Instead of using your name on the audio record and/or transcript of this interview, we will assign you a different name. When we write a report or article about this study or share the study data set with others, we will do so in such a way that you cannot be directly identified. Only the above-listed researchers will have access to the information that you provide. All records of this interview will be locked in a secure location.

WHOM SHOULD I CONTACT IF I HAVE QUESTIONS?

We encourage you to ask questions about this research at any time.  If you have any questions about the research study after this interview, please contact Dr Korb, the principle investigator, at abc@gmail.com or 0803 123 456. 

Your signature indicates that this research study has been explained to you, that your questions have been answered, and that you agree to take part in this study.  

Subject's Name (printed):  __________________________________________________________

__________________________________________	_______________________________
(Signature of Subject)						(Date)

Optional. Please tick your agreement to either use your name or audio record the interview. You may agree to not tick either but still fully participate in the research interview.

       I give you permission to audio record our conversation.
	
	I give you permission to directly quote me using my name in your research reports.

Statement of Person Who Obtained Consent

I have discussed the above points with the participant.  It is my opinion that the subject understands the risks, benefits, and procedures involved with participation in this research study and agrees to participate.

__________________________________________	_______________________________
(Signature of Person who Obtained Consent)			(Date)