The investigators will make every effort to safeguard the confidentiality of the information I provide. Any information obtained from this study that can be identified with me will remain confidential and will not be given to anyone without my permission.
If at any time I would like additional information about this project, I can contact Brandee Witbracht at Bradley University?s Nursing Department.
I understand that I have the right to refuse to participate in this study. I also understand that if I do agree to participate I have the right to change my mind at any time and stop my participation. I understand that grades and services I receive from Bradley University or my employment at__________________ will not be negatively affected by my refusal to participate or by my withdrawal from this project.
My signature below indicates that I have given my informed consent to participate in the above-described project. My signature also indicates that:
I have been given the opportunity to ask any and all questions about the described project and my participation and that all of my questions have been answered to my satisfaction.
I have been permitted to read this document and I have been given a signed copy of it.
I am at least 18 years old.
I am legally able to provide consent.
To the best of my knowledge and belief I have no physical or mental illness or weakness that would be adversely affected by my participation in the described project.
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Signature of Participant Date
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Signature of Witness Date