Dr. Aaron Seitz
Department of Psychology
University of California, Riverside
951-827-6422 || email@example.com
Dr. Susanne Jaeggi
School of Education
University of California, Irvine
949-824-5896 || firstname.lastname@example.org
You are asked to
participate in a research study conducted by Aaron Seitz, Ph.D., from the
of Psychology at UCR and Susanne Jaeggi, Ph.D., from the School of Education at
We plan to recruit up to 1,000 participants in this study. This experiment
concerns human cognition. Depending on your assigned condition you will view
stimuli, auditory stimuli or both. Auditory stimuli will be presented stimuli at
comfortable listening level either through speakers or headphones. Visual
will be presented either on a computer monitor, projector, or head mounted
You will be asked to make judgments on what you see and
Each experimental session will last up to 60 minutes. In
this experiment you are asked to participate in up to 22 such sessions
sessions ranges from 1 to 120 and must be written in before consent is signed).
These sessions consist of one or more test sessions that will be conducted
online, in which various aspects of your cognition will be assessed via
typical of cognitive neuropsychological examinations. In between these tests
sessions, you may be randomly assigned to a training group in which you will conduct
computer and/or paper based training activities, or a passive control group in which
you will conduct no activities, or an active control group in which you conduct
activities that are not expected to have an impact on the chosen assessments.
Your performance is monitored in each session and there may
be the possibility of a monetary bonus or enterence into a prize raffle based on
your performance during the experiment. Bonuses may be administered throughout the
experiment and/or on the completion of the experiment. These will be explained by
the experimenter prior to your signing this consent form.
Your data will be held strictly confidential. You will be
given a subject number, and all analysis and dissemination of the data will be
completed without any information that can identify you as a subject.
You will be allowed to ask questions at any time and will
be given periodic breaks throughout the session. You have the right to end your
participation at any time without penalty.
At the end of the session, the experimenter will be
available to answer any questions you have regarding the procedures and to explain
the purpose of the research. You are also welcome to contact Professor Aaron Seitz
via phone, (951) 827-6422, or e-mail, email@example.com, or Professor Susanne Jaeggi
via phone (949) 824-5896, or e-mail, firstname.lastname@example.org, to find out about the
research and findings.
You will be asked if you have epilepsy, suffer from
strokes, migraines or claustrophobia or if you have any other condition that may
cause a negative reaction to responding to repetitive stimuli in a small, dimly lit
chamber. Similarly, we may require that subjects have good or corrected vision and
Dr. Jaeggi has financial interests in MIND Research
Institute, an entity with interests related to this study. Dr. Jaeggi's spouse is
the Director of Education Research and receives salary and travel reimbursements
from MIND Research Institute, which is in addition to Dr. Jaeggi's salary from the
University of California, Irvine. The nature of this financial interest and the
design of the study have been reviewed by the UCI Conflict of Interest Oversight
Committee (COIOC). The COIOC has determined that the researcher's financial
interests are appropriately managed as to avoid compromising the quality or
reliability of the study. Furthermore, the UCI Institutional Review Board has
determined that appropriate safeguards are in place to avoid adversely affecting
your safety and welfare.
If you have any comments or questions regarding the conduct of
this research, please contact Professor Aaron Seitz at (951) 827-6422 or Professor
Susanne Jaeggi at (949) 824-5896. If you have any questions about your rights as a
research subject, please contact the UCR Office of Research Integrity at (951) 827-4811,
or to contact them by email, please use IRB@ucr.edu a
or call the UCI Office of the Human
Research Protection Program at (949) 824-0018, or contact them by email at
Please indicate here whether or
you consent to be contacted after the completion of this study for follow-up experiments
to this study. We occasionally run follow-up studies to examine long-term benefits from our
learning studies or to run additional tests regarding certain aspects of training benefits.
Having the ability to contact you can be invaluable to this research. For each follow-up you
will be asked to give a new consent. At any point you have the right to opt out of the
SIGNATURE OF RESEARCH SUBJECT
I have read (or someone has read to me) the information provided above.
I have been given an opportunity to ask questions and all of my questions have been
answered to my satisfaction. I have been given a copy of this form, as well as a copy
of the Subject's Bill of Rights.