UNIVERSITY OF WASHINGTON ASSENT FORM
Institute of Museum and Library Services & University of Washington Information School
Investigators:
Mike Crandall, Senior Lecturer, The Information School, (206) 897-1798, [email protected]
Karen Fisher, Associate Professor, (206) 543-6238, [email protected]
Chic Naumer, PhD Student, (206) 543-6238, [email protected]
Carol Landry, PhD Student, (206) 543-6238, [email protected]
Samantha Becker, MLIS Student, (206) 543-6238, [email protected]
Jack Baur, MLIS Student, (206) 543-6238, [email protected]
Ellie Bair, MLIS Student, (206) 543-6238, [email protected]
Sherry Edwards, MLIS Student, (206) 543-6238, [email protected]
Elizabeth Mitchell, MLIS Student, (206) 543-6238, [email protected]
*Please note that we cannot guarantee the confidentiality of information sent via e-mail
We are asking you to be in a research study being conducted by the University of Washington’s Information School and sponsored by the US government’s Institute for Museum and Library Services. We will give you information so that you can decide whether or not to be in the study. Please read the form carefully. You may ask questions now or later. When all your questions have been answered, you can decide if you want to be in the study or not.
We want to know more about how people use the free computers and Internet in public libraries. I would like to ask you some questions by yourself about your experiences with using the Library’s publicly accessible computers.
If you choose to be in this study, we would like to talk with you about your experiences using your public library’s computers to access information. It will take about 20-30 minutes and will focus on the different services that you have tried. For example, I will ask you “What types of computer and Internet services have you tried at the Library?” “What skills have you learned?” ‘How have you benefited from using the computer at the Library? and “How do you think access to the computer could be improved? You do not have to answer every question.
During the interview, you may refuse to answer any question. The interview will be audio recorded and transcribed. The audio recording of your voice will be destroyed within 6 weeks of being recorded. Only members of the research team listed above will have access to this potentially sensitive information.
RISKS, STRESS, OR DISCOMFORT
Some people do not want to take part in research.
ALTERNATIVES TO TAKING PART IN THIS STUDY
If you do not want to take part in this study, I will not interview you.
BENEFITS OF THE STUDY
You will not benefit from taking part in this study. Other people may learn when they read about the public access computing in public libraries.
You can choose to take part in this study, or not. You can stop at any time. Information about you is private and confidential except as provided by law. I will code the study information. I will keep the link between your name and the code until May 2009. Then I will destroy the link. I will not use your name in any reports, presentations or publications. You will be given $20 after the interview.
___________________________________________________________________________
Signature of investigator Printed Name Date
Subject’s statement
This study has been explained to me. I volunteer to be in this research. I can ask questions now or later. If I have questions about my rights, I can call the University of Washington Human Subjects Division at (206) 543-0098. I will receive a copy of this assent form.
____ I give permission for the researcher to audio record my interview.
____ I do not give permission for the researcher to audio record my interview
______________________________________________________________________________
Signature of subject Printed name Date
Copies to: Investigator’s file
Subject
Minor interview assent form January 19, 2009
| File Type | application/msword |
| File Title | SAMPLE FORMAT |
| Author | H. McGough |
| Last Modified By | Samantha Becker |
| File Modified | 2009-01-19 |
| File Created | 2009-01-19 |