INFORMED CONSENT FORM

IB Psychology Internal Assessment

John A. Ferguson High School
Mark Callado, Francisco Herrera, Alfredo Marenco, Carlos Sosa

You have been asked to take part in a research project described below. The
researcher will explain the project to you in detail. You should feel free to ask questions. If
you have more questions later, they will be discuss them with you.

Description of the project:

You have been asked to take part in the study that will evaluate the effectiveness of
memory recall. You will be asked to answer a small survey concerning a past examination.

Procedures:
If you decide to take part in this study here is what will happen:
You will be given a small survey to answer. The entire procedure should take no more
than ten minutes.

Risks or discomfort:
There are no risks of injury or discomfort.

Benefits of this study:

Although there will be no direct benefit to you for taking part in this study, the
researcher may learn more about memory recall.

Confidentiality:
Your part in this study is confidential and anonymous. Surveys will not be identified by
name. All data will kept only as evidence that the study was conducted.

Voluntary participation and withdrawal:

Participation in research is voluntary. You have the right to refuse to be in this study. If
you decide to be in the study and change your mind, you have the right to drop out at any
time.

Questions, Rights and Complaints:

If you have any questions about this research project, please call Carlos Sosa at (786)
619 4239 or email at Csosa009@@gmail.com
If you have any questions or concerns about your rights as a research participant in
this study, please direct them to Marta Cenac, the IRB Manager at Fuller Theological
Seminary, Human Subjects Review Office at (626) 584-5544.
Consent statement

By signing this document you consent to participating in the IB Psychology Internal

Assessment of Mark Callado, Francisco Herrera, Alfredo Marenco, Carlos Sosa at John. A.
Ferguson High School.

This statement certifies the following: that you are a student of John A. Ferguson High School
and you have read the consent and all your questions have been answered. You understand
that you may withdraw from the study at any time, and that you will participate anonymously.

________________________
Signature of Participant

_________________________
Typed/printed Name

__________________________
Date