Authorization To Use Your Information For Research Purposes
Your personal information cannot be used in this research study without your written authorization. If you sign this form, it will provide that authorization. This form is intended to inform you about how your information will be used or disclosed in the study. Your information will only be used in accordance with this authorization form and the informed consent form and as required or allowed by law. Please read it carefully before signing it.
What is the purpose of this research study and how will my information be utilized in the study?
The purpose of this research study is to achieve a better understanding of the dissonance that individuals may be feeling in relation to technology adoption and its uses in society. Your answers to the assessment questions will be analyzed to understand what many individuals think and feel about the performance of novel technologies and technology adoption overall. In future meetings and publications, your identity will not be disclosed when discussing the results.
Do I have to sign this authorization form?
It is not required for you to sign this form. But if you do not, you will not be able to participate in this research study.
If I sign, can I revoke it or withdraw from the research later?
If you decide to participate, you are free to withdraw your authorization regarding the use and disclosure of your information (and to discontinue any other participation in the study) at any time. After any revocation, your information will no longer be used or disclosed in the study, except to the extent that the law allows us to continue using your information (e.g., necessary to maintain integrity of research). If you wish to revoke your authorization for the research use or disclosure of your information in this study, you must write to the research team at dissonace_research@asdrp.org and sahar.jahanikia@asdrp.org
WITHDRAWAL FROM STUDY: The Protocol Director may also withdraw you from the study without your consent for one or more of the following reasons:
- Failure to follow the instructions of the Protocol Director and study staff.
- The study is canceled.
- Other administrative reasons
- Unanticipated circumstances
Contact Information: If you have any questions, concerns or complaints about this research study, its procedures, risks and benefits, you should ask the Protocol Director, Sahar Jahanikia at sahar.jahanikia@asdrp.org. You should also contact her at any time if you feel you have been hurt by being a part of this study.