Sample Templates

OHRP Informed Consent Checklist

Sample Informed Consent/Assent Templates

**Templates updated 5-21-2018 to include common rule changes

  • Adult Informed Consent Template  [PDF]   [DOC]
  • Exempt Informed Consent Template  [PDF]   [DOC]
  • Focus Group Consent Template   [PDF]   [DOC] 
  • Interview Consent Template   [PDF]   [DOC]  
  • Online Survey Consent Template   [PDF]   [DOC]  
  • Parental Permission Letter  [PDF]  [DOC]
  • Child Assent Script Sample (Age 7-13)  [PDF]   [DOC]
  • Child Assent Script Sample (Age 14-17)  [PDF]   [DOC]
  • Consent Form for Flint Psych Pool (Under 18)  [PDF] [DOC]
Self Determination Templates: If you plan to use the eResearch path for self determination of your exempt study, please use these templates for consent
  • Self-determination Exempt Informed Consent Template  [PDF]   [DOC]
  • Self-determination Focus Group Consent Template   [PDF]   [DOC] 
  • Self-determination Interview Consent Template   [PDF]   [DOC]  
  • Self-determination Online Survey Consent Template   [PDF]   [DOC]  

Sample Recruitment

  • Recruitment Template and  Guidelines  [PDF]   [DOC]
  • Template for use of UM-Flint Email for online survey [PDF] [DOC]

Sample Debriefing

  • Debriefing Template  [PDF]   [DOC]