Consent Form

The [TEAM NAME HERE] application is being produced as part of the coursework for Computer Science course CSE 440 at the University of Washington.  Participants in experimental evaluation of the application provide data that is used to evaluate and modify the interface of [TEAM NAME HERE].  Data will be collected by interview, observation and questionnaire. 

 

Participation in this experiment is voluntary.  Participants may withdraw themselves and their data at any time without fear of consequences.  And concerns about the experiment may be discussed with the researchers ([TEAM MEMBERS NAMES HERE]) or with Professor James Landay,  the instructor of CSE 440:

James A. Landay

CSE Department

University of Washington

206-685-9139

landay at cs.washington.edu

Participant anonymity will be provided by the separate storage of names from data.  Data will only be identified by participant number.  No identifying information about the participants will be available to anyone except the researchers and their supervisors.

 

I hereby acknowledge that I have been given an opportunity to ask questions about the nature of the experiment and my participation in it.  I give my consent to have data collected on my behavior and opinions in relation to the [TEAM NAME HERE] experiment.  I understand I may withdraw my permission at any time

 

 

Name ______________________________________________

 

Date _______________________________________________

 

Signature____________________________________________

 

Witness name ________________________________________

 

Witness signature_____________________________________