INFORMED CONSENT DOCUMENT

Investigator: ___Dr. Susan E. Stans, Instructor_______________________

Student Investigator:____________________________________________________

You are being asked to participate in a research project conducted through Florida Gulf Coast University. The University requires that you give your signed agreement to participate in this project. The investigator will explain to you in detail the purpose of the project, the procedures to be used, and the potential benefits and possible risks of participation. You may ask him/her any questions you have to help you understand the project. A basic explanation of the project is written below. Please read the explanation and discuss with the researcher any questions you may have.

If you decide to participate in the project, please sign this form in the presence of the person who has explained the project to you. You will be given a copy of this form to keep.

Nature and Purpose of the Project: To understand how individuals make decisions regarding their response, utilization, or conservation of their environment. Explanation of Procedures: All participants will be interviewed about their decisions to respond to the Southwest Florida environment through art, authorship, architecture, or activism.

Identification of any Experimental Medical Treatments or Procedures: There will be no medical treatments or procedures.

Discomfort and Risks: Do not answer any question that you feel uncomfortable in answering.

Benefits: By participation in the study, students will learn about conservation, ecology, and the environment, giving you the opportunity to share your views with an interested person. You will send a copy of the paper resulting from your interview if you include your name and address at the bottom of the form.

Confidentiality: All students are asked to respect the study in not disclosing information about you unless you agree to be identified. Because your views will be archived, you may find it satisfactory to have your name historically linked to your environmental perspective. Your name will not be used without your permission. The information will be used with others’ information to form a composite of decisions made regarding the SW Florida environment.

Explanation of Compensation: There will be no compensation given.

Refusal to participate in this study will have no effect on any future services you may be entitled to from the University. Anyone who agrees to participate in this study is free to withdraw from the study at any time with no penalty. I understand also that it is not possible to identify all potential risks in an experimental procedure, and I believe the reasonable safeguards have been taken to minimize both the known and potential but unknown risks.

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Signature (Agree to be interviewed)                            Date  

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THE DATED APPROVAL STAMP ON THIS CONSENT FORM INDICATES THAT THIS PROJECT HAS BEEN REVIEWED AND APPROVED BY THE FLORIDA GULF COAST UNIVERSITY INSTITUTIONAL REVIEW BOARD FOR THE PROTECTION OF HUMAN SUBJECTS IN RESEARCH. (941) 590-1000

Name and mailing address to receive paper copy of project:

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