ADULT CONSENT FORM

Time Customs and Sleep in American Indian Shift Workers

DOCUMENTATION OF INFORMED CONSENT

YOU ARE VOLUNTARILY MAKING A DECISION WHETHER TO PARTICIPATE IN THIS RESEARCH. YOUR SIGNATURE (WRITTEN OR ELECTRONIC) MEANS THAT YOU HAVE READ AND UNDERSTOOD THE INFORMATION PRESENTED AND DECIDED TO PARTICIPATE. YOUR SIGNATURE (WRITTEN OR ELECTRONIC) ALSO MEANS THAT THE INFORMATION ON THIS CONSENT FORM HAS BEEN FULLY EXPLAINED TO YOU AND ALL YOUR QUESTIONS HAVE BEEN ANSWERED TO YOUR SATISFACTION. IF YOU THINK OF ANY ADDITIONAL QUESTIONS DURING THE STUDY, YOU SHOULD CONTACT THE INVESTIGATOR(S). IF REQUESTED, YOU WILL BE GIVEN A COPY OF THIS CONSENT FORM.

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Signature of Subject Date


I CERTIFY THAT ALL THE ELEMENTS OF INFORMED CONSENT DESCRIBED ON THIS CONSENT FORM HAVE BEEN PROVIDED TO THE PARTICIPANT. THE SUBJECT IS VOLUNTARILY AND KNOWINGLY GIVING INFORMED CONSENT AND POSSESSES THE LEGAL CAPACITY TO GIVE INFORMED CONSENT TO PARTICIPATE IN THIS RESEARCH STUDY.


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Signature of Investigator Date

IDENTIFICATION OF INVESTIGATORS

PRIMARY INVESTIGATOR Office: (605) 394-5385 Rapid City, SD
Barbara Hobbs, PhD (cand.), RN Home (605) 718-6063  Note: This number has changed from the original consent form.  
Barbara_Hobbs@sdstate.edu

SECONDARY INVESTIGATOR Office: (402) 559-6634 Omaha, NE
Lynne Farr, Ph.D. Home: (402) 334-0284
lafarr@unmc.edu

By clicking on SHIFTWORK SURVEY SUBMIT, you are verifying you have read and understand the informed consent and have  decided to participate.