Consent Form

Informed Consent Form for Department Pool Participants Earning Credit IRB-FY2016-521

You are invited to take part in a research a Suzuki Lab study of cognitive function in college aged students. The study is designed to learn about cognitive function among college students. The research is being conducted by Dr. DJ Oberlin who is a postdoctoral fellow and his faculty sponsor Dr. Wendy A. Suzuki in the NYU Center for Neural Science. If you agree to be in this study, you will be asked to: complete 3 online cognitive tasks. Your participation will take about 30 minutes, and you will receive 0.5 credits. If you withdraw before the end of the study, you will receive credit for the time you have completed. If you choose not to participate, you can fulfill the course requirement in other ways besides participating in this study.

There are no known risks associated with your participation in this research beyond those of everyday life. Although you will receive no direct benefits for participation in this study, it may make you more aware of how knowledge is discovered in psychology and neuroscience, and will help the investigator better understand healthy cognitive function in college aged individuals.

Taking part in this study is voluntary. Not taking part or withdrawing from the study will not affect your grade or academic standing in any way. You have the right to skip or not answer any questions you prefer not to answer. When you complete the study, a thorough verbal and written explanation of it will be provided.

Confidentiality of your research records will be maintained by only collecting and storing de-identified information, and keeping all data in a secured server. Information not containing identifiers may be used in future research or shared with other researchers without your additional consent.

The researcher cannot keep information confidential if they have concerns that someone is hurting children, that someone is hurting you, or that you might hurt yourself or someone else. In such cases, they will inform people in authority about their concerns.

If there is anything about the study or taking part in it that is unclear or that you do not understand, or if you have questions or wish to report a research-related problem, you may contact the principal investigator, DJ Oberlin, at (212)998-3969, djo303@nyu.edu, 4 Wahsington Pl.10003; or the faculty sponsor, Prof. Wendy Suzuki, at (212)998-3969, ws21@nyu.edu, 4 Wahsington Pl.10003.

For questions about your rights as a research participant, you may contact the University Committee on Activities Involving Human Subjects (UCAIHS), New York University, (212) 998-4808 or ask.humansubjects@nyu.edu, 665 Broadway, Suite 804, New York, NY 10012.

By writing your name in the field below you grant your consent for the study.

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