Information Sheet for Completing a Survey
Principal Investigator: Dr. Emily Myers
Title of Project: Language and Brain Lab Research Registry
In the Language and Brain Lab, we run various studies examining speech comprehension and we are looking for participants! We are building a research registry, which is a list of people who are interested in participating in our research in the future and would like to be contacted about participation opportunities. This form includes information about signing up for our research registry. Our contact information is included below if you have any questions after reviewing this form.
What will I be asked to do?
In the following survey, you will be asked to provide:
- basic information about your background
- a brief health history
- your contact information
By completing this survey and providing your contact information, you agree to be contacted by the researchers about opportunities to participate in our research studies. After completing the survey, you may request to have your information removed from our research registry list any time by contacting the Language and Brain Lab at (860) 486-0931 or firstname.lastname@example.org.
How long will it take?
Filling out this survey should take approximately 15 minutes of your time.
Will I receive payment for completing the survey?
You will not be paid for completing this survey, but future participation in any of our research studies will be compensated.
What are the risks or inconveniences involved?
We do not anticipate any risks from answering the survey questions; however, a possible inconvenience may be the time it takes to complete the survey.
What are the benefits?
You may not directly benefit from completing this survey. However, the possible benefits of your future participation in research may impact society by helping researchers understand more about speech comprehension and language disorders, which may help develop new treatments in the future.
UConn IRB Protocol H21-0139 Approved May 23, 2022 1
How will my personal information be protected?
All the information you provide in this survey will be kept confidential by the researchers. Your information will be saved in an internet-based encrypted database and will only be accessed by approved members of our research team. Your name will be saved separately in a key that can only be accessed by approved members of our research team in order to further protect your identity and personal information. We will keep your information on file indefinitely; however, you may request that your information be removed at any time.
Your information will never be shared with anyone outside the research team and we will do our best to protect the confidentiality of the information we gather from you but we cannot guarantee 100% confidentiality. Your confidentiality will be maintained to the degree permitted by the technology used. Specifically, no guarantees can be made regarding the interception of data sent via the Internet by any third parties.
Can I stop completing the survey if I do not wish to continue and what are my rights?
You do not have to complete this survey if you do not want to. You do not have to answer any question that you do not want to answer for any reason. We will be happy to answer any questions you have about this survey. If you have further questions about this project or if you have a problem related to the survey, you may contact Dr. Emily Myers at 860-486-2630. If you have any questions about your rights as a research participant, you may contact the University of Connecticut Institutional Review Board (IRB) at 860-486-8802. The IRB is a group of people who review research studies to protect the rights and welfare of research participants.
Please print out a copy of this information sheet for your records.
If you would like to participate in this survey, click yes to begin or no to exit.
UConn IRB Protocol H21-0139 Approved May 23, 2022 2