Informed Consent

Dyadic Conversation on Cognitive Processing

Project Title and Purpose:
You are invited to participate in a research study on Dyadic Conversation on
Cognitive Processing. This is a study to examine how various factors affect
your ability to remember different types of stimuli.
Investigator(s):
This study is being conducted by Colin Lippert in a research methods class in the
Psychology Department at Queens University of Charlotte. The study is part of an
individual project under the direction of Dr. Cherie Clark in the Psychology
Department.
Description of Participation:
In this study you will be asked to communicate with a confederate for 5 minutes
then complete a cognition test.
Length of Participation
Your participation in this project will take approximately 20 minutes. If you decide
to participate, you will be one of approximately 40 participants in this study.
Participants will be drawn on a convenience basis from contacts in the student
population at Queens University of Charlotte and from the Charlotte community.
Risks and Benefits of Participation:
There are no risks known at this time associated with participating in the study.
However, there may be risks, which are currently unforeseeable. The only benefit
of participation in this study is the knowledge you will gain about the topic being
investigated. You will receive a snack for participating. You will receive a
complete description of the study when you are finished participating. The
results of the study will only be used for this class project. You may obtain a copy
of all results by contacting me any time after April 21, 2015. At email address
colin.lippert@queens.edu. You will not receive financial reimbursement for your
participation; however, your instructor may give you extra credit.
Volunteer Statement
You are a volunteer. The decision to participate in this study is completely up to
you. If you decide to be in the study, you may stop at any time. You may skip
any item you do not wish to answer. You will not be treated any differently if you
decide not to participate or if you stop once you have started.
Page 1 of 2

Confidentiality:
All information you provide will be kept confidential; numbers, only, are used as
identification, no names will appear with the data. All data files will be destroyed
at the end of the project.
Fair Treatment and Respect:
Queens University of Charlotte wants to make sure that you are treated in a fair
and respectful manner. Contact the Universitys Institutional Review Board (Dr.
Laree Schoolmeesters at 704.688.2743) if you have any questions about how you
are treated as a study participant. If you have any questions about the project,
please contact Colin Lippert at colin.lippert@queens.edu
Participant Consent:
I have read the information in this consent form. I have had the chance to ask
questions about this study, and those questions have been answered to my
satisfaction. I am at least 18 years of age, am an emancipated minor*, or my
guardian has signed below, and I agree to participate in this research project. I
understand that I will receive a copy of this form after it has been signed by me
and the researcher.

________________________
Participant Name
(PLEASE PRINT)

_____________________________
Participant Signature

______________________________________
Researcher Signature

_____________
DATE

_____________________
DATE

*Emancipated Minor (as defined by NC General Statute 7B-101.14) is a person

who has not yet reached their 18th birthday and meets at least one of the
following criteria: 1) has legally terminated custodial rights of his/her parents
and been declared emancipated by a court; 2) is married, or 3) is serving in the
armed forces of the United States.

Page 2 of 2