CONSENT TO PARTICIPATE IN SURVEY Title of Project: Cradle Me 3 Project Principal Investigator: Shinel M. Stephens, MSN, NP-C Student Health & Counseling Services P.O. Box 19491 Durham, NC 27707 919-530-6317 email@example.com
You are being asked to participate in a survey. Completion of the survey is voluntary. If you decide to complete the survey, you will be one of approximately 1300 students who will participate. Details about this survey are being discussed below. It is important that you understand this information so that you can make an informed choice about whether you want to participate in this survey.
Background and Purpose: The purpose of this survey is to evaluate the effectiveness of using peer educators to provide support and education in the areas of preconception, pregnancy, and parenting among college students. Survey participants are being recruited from the incoming freshmen class of 2013 at North Carolina Central University. You must be 18 years of age or older to participate in this survey.
Duration and Location: Participation in this survey will occur with incoming freshmen beginning September 9, 2013 – October 7, 2013. It is anticipated that it will take 5-15 minutes to complete the survey. The survey will then be distributed on an annual basis as the student matriculates through the university until 2017. Remaining survey distribution dates to be determined.
Procedure: In this survey you will be asked to complete a questionnaire regarding your medical health and your feelings about having a child. If you have ever been pregnant and delivered a baby you will be asked questions regarding your medical health during your pregnancy and following the delivery of your baby. You will complete the survey online.