IRB
Administration Approved, Standard Consent Form for Exempt Research |
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CONSENT
TO ACT AS A HUMAN RESEARCH SUBJECT |
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UNIVERSITY OF CALIFORNIA IRVINE |
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Survey of
Travel Behavior Changes Associated with a Shared-use Electric Vehicle Pilot
Program |
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TITLE OF STUDY |
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Michael G. McNally, Institute of Transportation
Studies, 824-8462, |
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NAME, DEPARTMENT AND TELEPHONE NUMBER OF
INVESTIGATOR |
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You have been asked to participate in a research
study which is exempt from review by an Institutional Review Board. The purpose of the study, terms of your
participation, as well as any expected risks and benefits, must be fully
explained to you before you sign this form and give your consent to
participate. |
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You should also know that participation in
research is entirely voluntary. You may refuse to participate, or may
withdraw from participation at any time without jeopardy to future medical
care, education or employment status, or other entitlement. However, by voluntarily refusing or
withdrawing from the survey, you renounce your right of participating in the
e.com program. |
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The investigator may withdraw you from
participation at his/her professional discretion. |
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If, during the course of this study, significant
new information which has been developed during the study becomes available,
which may relate to your willingness to continue to participate, this
information will be provided to you by the investigator. |
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Any information derived from this research
project which personally identifies you will not be voluntarily released or
disclosed without your separate consent, except as specifically required by
law. |
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If at any time you have questions regarding this
research or your participation in it, you should contact the investigator or
his/her assistants who must answer your questions. |
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If, at any time, you have comments regarding the
conduct of this research or if you wish to discuss your rights as a research
subject, you may contact the Office of Research Administration at (949)
824-6068 or (949) 824-2125. |
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You will be given a copy of this consent form to
keep. |
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I consent to participate in this study. |
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SIGNATURE
OF SUBJECT (Age 7 and older*) DATE |
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*SIGNATURE
OF PARENT/GUARDIAN (if subject is under 18) DATE |
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SIGNATURE
OF INVESTIGATOR DATE |
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THIS FORM IS FOR USE WITH
EXEMPT RESEARCH ONLY |
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