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Consent Form for Participation in the Research Study Entitled A Community–Based Needs Assessment of an Urban Rhode Island Community |
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Principal investigator |
Co-Investigator |
For questions/concerns about your research rights, contact: |
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Site Information |
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Description of Study: Concetta Archer is a doctoral student engaged in research for the purpose of satisfying a requirement for a Doctor of Education degree. The purpose of this study is to undertake a community–based needs assessment for Federal Hill House Association. If you agree to participate, you will be asked to complete a survey that can be found online at www.needs2know.com or a paper and pencil survey available at Federal Hill House Association , 9 Courtland St, Providence, Monday through Friday 9am to 6pm. or Seven Stars Bakery, 345 Broadway, Providence, Monday through Friday 6:30am to 6pm; Saturday and Sunday 7 am to 4 pm. Federal Hill House Association will use the data collected from this survey to determine if the agency is meeting the needs of residents, employers and the community at large. The information gathered through the needs assessment will be used to help shape future programs by identifying the unmet needs of the community. Residents are being asked to complete a survey that will take approximately 30 minutes to complete and business owners are being asked to complete a survey that will take about 15 minutes to complete. Risks/Benefits to the Participants: There may be minimal risk involved in participating in this study. There are no direct benefits to for agreeing to be in this study. If you have any concerns about the risks/benefits of participating in this study, you can contact the primary investigators, Concetta Archer at 401-421-4722 or Roz Doctorow and/or the university’s human research oversight board (the Institutional Review Board or IRB) at the numbers listed above. Cost and Payments to Participants: There is no cost for participation in this study. Participation is completely voluntary and no payment will be provided. Confidentiality: Information obtained in this study is strictly confidential unless disclosure is required by law. All data will be secured in a locked filing cabinet. Your name will not be used in reporting of information in publications or conference presentations. Participant’s Right to Withdraw from the Study:You have the right to refuse to participate in this study and the right to withdraw from the study at any time without penalty. I have read this letter and I fully understand the contents of this document and voluntarily consent to participate. All of my questions concerning this research have been answered. If I have any questions in the future about this study they will be answered by the investigator listed above or his/her staff. I understand that the completion of this questionnaire implies my consent to participate in this study. |
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