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FLAB Survey Consent Form

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favouradesina1998
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18 views3 pages

FLAB Survey Consent Form

Uploaded by

favouradesina1998
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Carnegie Mellon University

Consent Form for Participation in Research

Study Title: Exploring Travel Preferences of Young, Lower-Income Individuals

Contact Information:
Amy Lucas, Lukas Chen, Bhavya Jha, Favour Adesina - Students
Carnegie Mellon University
300 S. Craig St.
Pittsburgh, PA 15213
517-715-3424
[email protected]

Purpose of this Study


This study is part of a course in the Carnegie-Mellon University, Human-Computer Interaction
program. Students need to learn about your experience as part of their course project. The
purpose of the study is to understand the travel preferences of students and other young
lower-income individuals, especially in the collaborative travel planning space.

Summary

This study will aid in the understanding and creation of a new travel planning platform. The
platform will help lower-income young people collaboratively plan cost-effective trips that are
accessible for many different budget constraints.

Procedures
● Users are provided with a consent form stating what kind of information is to be
collected and seeking permission.
● Once the user has signed the form, we will conduct an interview and share multiple
storyboards with them.
● We will ask a leading question and discuss the storyboards.
● If the interview session is done remotely, we will record on Zoom
● We will do a brief wrap and reflection to answer any questions you may have
● The procedure has now come to an end.

Estimated Duration for Interview: 30-60 minutes


Location: Remote

Participant Requirements

Consent Form to Participate in Research p .1


Carnegie Mellon University

Participants must be 18-30 years of age. They must have planned a trip or participated in
planning a trip in the last 4 years.

Risks
The risks and discomfort associated with participation in this study are no greater than those
ordinarily encountered in daily life or during typical computer use.

Compensation & Costs


There is no compensation for participation in this study.
There will be no cost to you if you participate in this study.

Future Use of Information


In the future, once we have removed all identifiable information from your data (information
or bio-specimens), we may use the data for our future research studies, or we may distribute
the data to other investigators for their research studies. We would do this without getting
additional informed consent from you (or your legally authorized representative). Sharing of
data with other researchers will only be done in such a manner that you will not be identified.

Confidentiality
By participating in the study, you understand and agree that Carnegie Mellon University may be
required to disclose your consent form, data and other personally identifiable information as
required by law, regulation, subpoena or court order. Otherwise, your confidentiality will be
maintained in the following manner:

Your data and consent form will be kept separate. Your research data will be stored in a secure
location on Carnegie Mellon University property. By participating, you understand and agree that
the data and information gathered during this study may be used by Carnegie Mellon University
and published and/or disclosed by Carnegie Mellon University to others outside of Carnegie
Mellon University. However, your name, address, contact information and other direct personal
identifiers will not be mentioned in any such publication or dissemination of the research data
and/or results by Carnegie Mellon University.

The researchers will take the following steps to protect participants’ identities during this study:
(1) Any original recordings or data files will be stored in a secured location accessed only by
authorized researchers.

Optional Permission
I understand that the researchers may want to use a short portion of any video or audio
recording for illustrative reasons in presentations of this work for scientific or educational
purposes. I give my permission to do so provided that my name and face will not appear.

Please initial here: _______YES ________NO

Consent form for Participation in Research | 2


Carnegie Mellon University

Rights
Your participation is voluntary. You are free to stop your participation at any point. Refusal to
participate or withdrawal of your consent or discontinued participation in the study will not
result in any penalty or loss of benefits or rights to which you might otherwise be entitled. The
researcher may at his/her discretion remove you from the study for any of a number of reasons.
In such an event, you will not suffer any penalty or loss of benefits or rights which you might
otherwise be entitled.

Right to Ask Questions & Contact Information


If you have any questions about this study, you should feel free to ask them now. If you have
questions later, desire additional information, or wish to withdraw your participation please
contact the researcher by mail, phone or e-mail in accordance with the contact information
listed on the first page of this consent.

Voluntary Consent

By signing below, you agree that the above information has been explained to you and all your
current questions have been answered. You are encouraged to ask questions about any aspect
of this research study during the course of the study and in the future. By signing this form, you
agree to participate in this research study. A copy of the consent form will be given to you.

PRINT PARTICIPANT’S NAME

PARTICIPANT SIGNATURE DATE

I certify that I have explained the nature and purpose of this research study to the above
individual and I have discussed the potential benefits and possible risks of participation in the
study. Any questions the individual has about this study have been answered and any future
questions will be answered as they arise.

SIGNATURE OF PERSON OBTAINING CONSENT DATE

******************************************************************************
*******

Consent form for Participation in Research | 3

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