Rose Eligibility Questionnaire

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Consent Form

Introduction
The purpose of this form is to provide you information that may affect your decision as to whether or not to participate in research at the University of Texas. Please read the information below and ask any questions you might have before deciding whether or not to take part. You must be at least 18 years old to participate.

If you agree to participate:

o The prescreen survey will take approximately 10 minutes of your time. This survey will determine your initial eligibility and ask about your demographic information and mental and physical health status.

o If you appear to be eligible, we will contact you to schedule your in-person laboratory visits.

o You will not be compensated for the eligibility screening portion of the study. However, if you are found to be eligible and enroll into the study, you will receive compensation for your participation.

Purpose of the Study
You have been asked to participate in a prescreening survey to determine your eligibility for a research study about the way social anxiety changes or remains stable among individuals with elevated social anxiety levels. A description of the study will be available on http://www.ClinicalTrials.gov as required by U.S. Law. This website will not include information that can identify you. At most, the website will include a summary of the results. You can search this website at any time.

Risks/Benefits/Confidentiality of Data

There are some possible risks or discomfort which could cause you to feel uncomfortable, embarrassed, or bored, while completing the prescreen surveys. There will be no costs for participating, and your participation is voluntary. Your name and email address will be kept during the data collection phase for tracking purposes only. A limited number of research team members will have access to the data during data collection. Identifying information will be stripped from the final dataset. De-identified data may be shared with other researchers for research purposes.

Participation or Withdrawal

Your participation in this study is voluntary. You may decline to answer any question and you have the right to withdraw from participation at any time. Withdrawal will not affect your relationship with The University of Texas in any way. If you do not want to participate, please close this window to exit the survey.

Contacts

You may contact the research coordinator with any questions you may have at UTrosestudy@gmail.com.

Questions about your rights as a research participant.

The following studies have been reviewed by The University of Texas at Austin Institutional Review Board. If you have questions about your rights or are dissatisfied at any time with any part of this study, you can contact, anonymously if you wish, the Institutional Review Board by phone at (512) 471-8871 or email at orsc@uts.cc.utexas.edu.

If you agree to participate in the screening process, please check "I agree" below.

Thank you.

Agreement Confirmation

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I agree

I do not agree

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