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Consent Form Script
X University
Institutional Review Board
INFORMED CONSENT
You are being asked to participate in a research study being conducted in our class. The purpose
of this is to obtain information on how advanced ESL students spontaneously attend to English
language forms. More specifically, I am interested in how different genders and cultures
spontaneously attend to form. Obtaining such information will better help ESL teachers and
researchers develop materials and techniques aimed at improving all ESL students' participation
in ESL classroom activities and their knowledge of English language forms.
Participation in the study requires no additional work on your behalf. We will do our normal
classroom activities. However, during group work, I will record your participation in the
particular group work activity that we are doing.
Your participation in this study is completely voluntary. If you agree to participate, at any time
while being recorded, you may decide to cease being recorded. There are no penalties for
refusing to participate in this study. No class privileges will be denied you should you decline to
participate or change your mind about participating.
Since your participation will be kept strictly confidential, feel free to participate as you normally
do. Do you have any questions? If you have any questions about the laws and procedures of
human subject research in the United States of America, you may contact me at [phone], my
research advisor, Dr X at [phone], or the Institutional Review Board at [phone].
I have read the Informed Consent script. Completion of the survey instrument indicates consent
of the subject to freely and willingly participate in the study.
____________________________________________________ _______________
Signature Date
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CONSENT FORM
Project Title: __________________________________________________________________
Investigator: Lee-Young Min, College of X, X University,
Philadelphia, [phone]
Advisor: Dr. X, College of X, X University
Philadelphia, [phone]
Purpose of Research
My research examines whether L2 (English as a second language) learners’ perspectives on
reading-writing relationships (ie, the range of the views on integrating reading and writing) can
help to explain the literacy behaviors in the context of university reading for writing class. This
research will explore the role of the L2 learners’ perspectives on reading-writing relationships
and their influence on literacy behaviors. Three types of data will be collected. The questionnaire
I developed will access the range of the views on integrating reading and writing held by L2
learners. Data collected from classroom observation will be analyzed to examine what, if any, the
similarities and differences in the approaches to reading-writing behaviors (ie, ways of
connecting reading and writing behaviors or ways of engaging in reading-writing activities in the
classroom) between the groups located at the different ranges of views on reading-writing
relations are. Student interview will also be conducted and analyzed to examine the similarities
and differences in the approaches to reading-writing behaviors.
General Experimental Procedures
I understand that I will participate in a research study which will be conducted in my English X
class throughout this semester. I understand that throughout the semester period I will be
observed in the classroom and will be interviewed outside the classroom by the researcher. I also
consent that I will provide the data including my writing assignments, reading journals and
narratives upon the researcher’s request.
Confidentiality
I understand that the data I will provide will be recorded with pseudonyms and any data about
me that will be collected by the researcher will be held in the strictest confidence. The data will
be kept for the duration of the study and they will be destroyed after the completion of the study.
Disclaimer/Withdrawl
I understand that my participation in this study is on voluntary basis, and I may refuse to
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participate at any time without consequence or prejudice.
Institutional Contacts
I understand that if I have questions about my rights as a research subject, I can contact Mr X,
the Coordinator for Research, Institutional Review Board, X University, [address], phone
[phone].
Signing my name below indicates that I have read and understood the contents of this Consent
Form and that I agree to take part in this study.
_________________________________________________ ______________________
Participant's Signature Date
_________________________________________________ ______________________
Investigator's Signature Date
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