Survey consent form (BREB approved project) – Sample

Project Title

WHO IS CONDUCTING THE STUDY?
[Name, title and contact information of project lead and any other relevant team members]

WHO WILL BE ANALYSING THE DATA?
Data will be analyzed by [Name, title and position of person in charge of collecting and analyzing the data].

WHY ARE WE DOING THIS STUDY?
The purpose of this study is to [briefly and clearly explain why this is being done; what is the goal of the study]. Your responses will be used to [briefly and clearly describe what will be done with the data; what will be the output of the study, for example: “Anonymized data from this study may be published in academic research journals and may also be presented at scholarly conferences.”] Aggregate data and/or anonymized quotes may also be shared publicly.

WHAT WILL HAPPEN IN THIS STUDY?
You will be asked to complete a [XX minute] survey. Your participation in the survey is anonymous [amend if student IDs are being collected], voluntary and will not impact your grade; your instructor will not see the data until final grades have been submitted and you may stop responding to the survey at any time.

ARE THERE ANY RISKS IN TAKING PART IN THIS STUDY?
Participating in this study could in no way be harmful to you.

WHAT ARE THE BENEFITS TO YOU PARTICIPATING IN THIS STUDY?
The result may impact you by [what will be done with the results? describe any benefit to participation] and your responses will contribute to resources for the purposes of advancing teaching and learning practices at UBC and beyond

CONFIDENTIALITY
Data will be securely stored on encrypted computers and shared between the researchers using a FIPPA and PIPEDA compliant (federal government mandated) tool. Instead of using names or any identifiable information (e.g. student numbers), codes will be used to protect the identity of the participants [if accurate]. The Principal Investigator will only have access to the anonymized data [if accurate]. The information gathered from the surveys will be stored for 5 years at UBC on a secure and encrypted data storage system.

[If applicable: In line with current best practices in education research, electronic data will be preserved for future use in open science initiatives. Open science initiatives allow for researchers from different universities to share their data upon completion of studies, in an effort to stimulate further use and exploration of existing data sets. Data is uploaded to an online forum in the form of a computer file, and these files are stripped of any information that could identify participants (e.g., names), to ensure confidentiality and anonymity.]

WHO CAN YOU CONTACT IF YOU HAVE QUESTIONS ABOUT THE STUDY?
If you have any concerns or complaints about your rights as a research participant and/or your experiences while participating in this study, contact the Research Participant Complaint Line in the UBC Office of Research Ethics at 604-822-8598 or if long distance e-mail RSIL@ors.ubc.ca or call toll free 1-877-822-8598.

CONSENT
Your participation in this study is entirely voluntary and you may refuse to participate or withdraw from the study at any time. By completing this survey you consent to participate in this study and having your responses included in the analyses.