Renee Bateman, MPH, CHES
Health Promotion Coordinator
Student Health Services
renee.bateman@sru.edu
724-738-4206

McLachlan Student Health Center
Slippery Rock, Pa  16057-1326
(724) 738-2052 Phone
(724) 738-2078 Fax
http://www.sru.edu/pages/266.asp

CONSENT TO PARTICIPATE IN RESEARCH

The e-CHUG Alcohol Intervention

Do not participate if you are under the age of 18 or if you are pregnant

Purpose: Student Health Services is conducting a study regarding Slippery Rock University students’ perceptions and behavior regarding alcohol and other drugs.  You have been selected to participate because you are a student at SRU.  This research will be used to design and implement educational programs about alcohol and other drugs at SRU.

Voluntary Participation Statement: Your participation in this research project is voluntary.  If you choose to participate, you may withdraw from the study at any time and no one will hold it against you.  Participation in the study will not affect your (grades, standing, etc) in the University.  In addition, your participation in the study may be terminated without your consent if the investigators determine it is unsafe for you to continue or you are not able to complete the research. 

How to Participate and Confidential Information: If you would like to complete the survey, click on the begin button. Completing the survey will serve as your consent to participate. You will be provided with an identification number, which only you will know.  Please write this number down if you wish to re-enter the site and track your progress.  Your responses are confidential and anonymous, meaning that there is no way for anyone to match your responses to you.  Confidentiality will be protected to the extent that is allowed by the law.

Compensation: The program should take about 20 minutes to complete.  Students completing the survey are eligible for one of three drawings to win either a $100.00 VISA gift card, $75.00 SGA Bookstore gift card or a $25.00 Giant Eagle gift card.  Winners will be randomly selected.  For details regarding the drawing view the resources tab.  If you choose to be in the drawing, the information you supply to enter the drawing is kept separate from your survey responses and cannot be used for identification purposes.

Risks/Benefits: There are no risks to participating in the survey.  Immediate benefits include: personalized feedback, education regarding alcohol and social norms and an opportunity to gain information about departments on campus and organizations in the community who you can contact if they wish to seek help with an alcohol related problem.  Programming specifically targeting SRU students will be created based on your participation. It is free and confidential to participate in the survey. 

Inquiries:  Please feel free to print out this consent form.  Please ask any questions or voice any concerns you may have now or at any time during the study.  If you have any questions about the research study, you should contact the researchers at the phone numbers listed at the top of this form.  If you have questions about your rights as a participant in this study or the way the study has been conducted, you may contact the IRB office by telephone at (724) 738-4846 or by e-mail at irb@sru.edu

Thank you for your time and participation.