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User Consent Form

USER CONSENT TO PARTICIPATE IN RESEARCH

Modular Digital Course in Undergraduate Neuroscience Education

You are asked to participate in a research study conducted by Dr. William Grisham, from the Psychology Department at the University of California, Los Angeles. You were selected as a possible participant in this study because you are participating in a course using teaching modules developed in the UCLA Psychology Department. Your participation in this research study is voluntary.

PURPOSE OF THE STUDY

This study is designed to test the efficacy of these teaching modules and provide feedback for the revision of the current modules and development of future modules.

PROCEDURES

If you volunteer to participate in this study, we would ask you to do the following:

  • Take a quiz before and after completing the module and fill-out an opinion questionnaire about your experiences with the module.
We may receive your grade on the module from your instructor but your grade will only be identified by the 5 digit code that your instructor gives you and we will not be able to link your grade to your name.

POTENTIAL RISKS AND DISCOMFORTS

We anticipate that you will experience no real risks or discomforts by participating in this study.

POTENTIAL BENEFITS TO SUBJECTS AND/OR TO SOCIETY

Your participation in the research may actually help you understand the module better. The results of the research may help us revise this module to make it a better, more effective teaching tool and help us develop future teaching tools to disseminate for free.

PAYMENT FOR PARTICIPATION

You will receive no payment for your participation but will receive our thanks.

CONFIDENTIALITY

Any information that is obtained in connection with this study and that can be identified with you will remain confidential and will be disclosed only with your permission or as required by law. Confidentiality will be maintained by means of maintaining your data only indexed only by numerical codes. Data will be kept on password protected desktop computers kept under lock and key. Only investigators directly involved with this project will have access to the data.

PARTICIPATION AND WITHDRAWAL

You can choose whether to be in this study or not. If you volunteer to be in this study, you may withdraw at any time without consequences of any kind. You may also refuse to answer any questions you don’t want to answer and still remain in the study. The decision whether or not to participate in this research will not affect your relationship with your instructor or your grade in the class.

IDENTIFICATION OF INVESTIGATORS

If you have any questions or concerns about the research, please feel free to contact:

William Grisham, Ph.D.
Department of Psychology
UCLA
1285 Franz Hall
P.O. Box 951563
Los Angeles, CA 90095-1563

grisham@lifesci.ucla.edu
(310) 825-7990

RIGHTS OF RESEARCH SUBJECTS

You may withdraw your consent at any time and discontinue participation without penalty. You are not waiving any legal rights because of your participation in this research study. If you have questions regarding your rights as a research subject, contact the Office for Protection of Research Subjects, UCLA, 11000 Kinross Avenue, Suite 102, Box 951694, Los Angeles, CA 90095-1694, (310) 825-8714.

National Science Foundation            UCLA Office of Instructional Development

Funded by the National Science Foundation and the UCLA Office of Instructional Development