Research Study on Mental Chronometry Test using Reaction Time

This research study aims to measure reaction time and cognitive speed through mental chronometry test using reaction time. The study has no risks except for psychological stress due to apprehension. Participation can inform you about your response time to visual stimuli. Your identity will be kept anonymous and confidential.

Title of Study:
Investigators:
Name
: Dept: Phone:
Name
: Dept: Phone:
Name
: Dept: Phone:
[sample text in brackets]
Introduction
 You are being asked to be in a research study of mental chronometry test using reaction time.
 You were randomly selected as a possible participant because you qualify the required age
group.
 We ask that you read this form and ask any questions that you may have before agreeing to
be in the study.
Purpose of Study
 The purpose of the study is to measure reaction time.
 Ultimately, this research may be published in a research paper.
Description of the Study Procedures
 If you agree to be in this study, you will be asked to do the following things:
Install the software for the experiment
Use the software
Risks/Discomforts of Being in this Study
 The study has only the risks of psychological stress due to apprehension
Benefits of Being in the Study
 The benefits of participation are that it can inform you about your response time to visual
stimuli and thus your cognitive speed.
Confidentiality
 This study is anonymous. We will not be collecting or retaining any information about your
identity.
 The records of this study will be kept strictly confidential. Research records will be kept in a
locked file, and all electronic information will be coded and secured using a password
protected file. We will not include any information in any report we may publish that would
make it possible to identify you.
Right to Refuse or Withdraw
 The decision to participate in this study is entirely up to you. You may refuse to take part in
the study at any time without affecting your relationship with the investigators of this study
or Smith College. Your decision will not result in any loss or benefits to which you are
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otherwise entitled. You have the right not to answer any single question, as well as to
withdraw completely from the interview at any point during the process; additionally, you
have the right to request that the interviewer not use any of your interview material.
Right to Ask Questions and Report Concerns
 You have the right to ask questions about this research study and to have those questions
answered by me before, during or after the research. If you have any further questions about
the study, at any time feel free to contact me, [name] at [email] or by telephone at [phone
number]. If you like, a summary of the results of the study will be sent to you. If you have any
other concerns about your rights as a research participant that have not been answered by the
investigators, you may contact us.
 If you have any problems or concerns that occur as a result of your participation, you can
report them to the researcher at the number above.
Consent
 Your signature below indicates that you have decided to volunteer as a research participant
for this study, and that you have read and understood the information provided above. You
will be given a signed and dated copy of this form to keep, along with any other printed
materials deemed necessary by the study investigators.
Subject's Name (print):
Subject's Signature: Date:
Investigator’s Signature: Date:
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