If you would like to be a participant in our registry, please read the informed consent below.
University of Wisconsin – Milwaukee
Consent to Participate in Online Survey Research
Study Title: Center for Aging and Translational Research Participant Registry
Person Responsible for Research (Principal Investigator (PI)):
Study Description: The purpose of this study is to create and maintain a research participant database of those individuals who are interested in learning about and potentially participating in future studies being conducted by scientists affiliated with the Center for Aging and Translational Research. This study is being conducted at the University of Wisconsin-Milwaukee. Five thousand people (ages 18-90+ years) will become part of this participant database.
What will I be asked to do if I participate in the study?
If you agree to participate you will be asked to:
- Read and sign this informed consent document allowing us to contact you at a future date to inform you of new research opportunities/protocols.
- Provide us with your name, address, phone number, and/or email address, which will be stored in a secure, password protected electronic database.
- Complete a short enrollment questionnaire containing 18 questions about your health status and caregiver status. The questions will be used for screening for whether you are eligible to participate in future studies.
What happens after I enroll in the participant registry?
- When Center Scientists are starting a new study, they will contact the Center to find out if any individuals in the participant registry database are eligible to participate in their new study.
- The Center will use the Center Scientists’ criteria to see who might be eligible to be part of the study. The Center staff will create a list of potential individuals who could participate in the study, and will give a copy of the list to the Center Scientist.
- A member of the study team, such as the Center Scientist or a student assistant, will contact the individuals on the list to see if they would like to participate in the new study. If you are contacted about participating in a new study, you can decide whether or not you would like to be part of the study.
- If you want to be part of the new study, a member of the study team will explain the study and everything that you would have to do to be part of the study.
- If you do not want to be part of the new study, you can say that you do not want to be in the study, and you will not be contacted again about that study.
Risks / Benefits: Risks to participants are considered minimal. Collection of data and survey responses using the internet involves the same risks that a person would encounter in everyday use of the internet, such as breach of confidentiality. While the researchers have taken every reasonable step to protect your confidentiality, there is always the possibility of interception or hacking of the data by third parties that is not under the control of the research team.
There will be no costs for participating. There are no benefits to you other than to further research.
Limits to Confidentiality: Identifying information such as your name, address, phone number, and email address will be collected to add to our participant registry database so that you can be contacted about studies you may want to participate in in the future. Data will be retained on the Qualtrics website server for up to three months and will be deleted after this time. However, data may exist on backups or server logs beyond the time frame of this research project. Data transferred from the survey site will be saved in an encrypted format for as long as you remain active in the participant registry database. Only the PI, Co-Investigator and authorized Center research personnel (such as student research assistants) will have access to the data collected by this study. If you qualify for a new study, Center Scientists will have access to your contact information. However, the Institutional Review Board at UW-Milwaukee or appropriate federal agencies like the Office for Human Research Protections may review this study’s records.
Voluntary Participation: Your participation in this study is voluntary. You may choose to not answer any of the questions or withdraw from this study at any time without penalty. Your decision will not change any present or future relationship with the University of Wisconsin Milwaukee.
If you decide to enroll in the participant registry now, and later decide that you do not want to be contacted regarding future studies, we will remove you from the registry and you will not be contacted about any additional future studies. If you would like to be removed from the registry, please email firstname.lastname@example.org with the subject line “Remove From Registry” and include in the body of the email your name and phone number so that we can remove the correct record from the database. Alternatively, you may call the CATR office at 414-229-7319 and ask to be removed from the registry. The person who answers the phone will ask for your name and phone number so that we can remove the correct record from the database.
In addition, you have the right to refuse to participate in any future study, but still remain part of the participant registry database to be contacted about other studies. If you do not want to participate in a study, you can inform the person who contacts you that you do not want to be part of that study.
Who do I contact for questions about the study: For more information about the study or study procedures, contact:
Who do I contact for questions about my rights or complaints towards my treatment as a research subject? Contact the UWM IRB at 414-229-3173 or email@example.com
Research Subject’s Consent to Participate in Research:
By entering this survey, you are indicating that you have read the consent form, you are age 18 or older and that you voluntarily agree to participate in this research study.