WEB CONSENT FORM

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The University Center for Social and Urban Research (or "UCSUR") at the University of Pittsburgh regularly conducts surveys and other research studies with local residents.  The studies cover a variety of topics and require different types of participants.  Some are conducted directly by UCSUR, and others are conducted with faculty from Pitt and other local Universities like Carnegie Mellon and Duquesne.

We are currently building a registry of local residents who are willing to be contacted for future surveys and research studies.  Being included does not mean that you are committing to anything or that you will definitely be contacted.  You would only be allowing us to include you in a list of potential participants.

There are no foreseeable risks associated with this project, nor are there any direct benefits to you.  This registry is being directed by Dr. Scott Beach, who can be reached at 412-624-5442.  The decision to be added to the registry is voluntary, and you would be free to have your name removed at any time.  Also, participation is voluntary for any study for which you would be called and asked to participate.

We will not be offering any incentive to join the registry, but individual studies for which you are contacted may offer payment for participation.

If you agree, we will ask for your contact information, including your name, telephone number, and e-mail address (if you have one).

At a follow-up phone call, we will also collect demographic information for inclusion in the registry, including age, gender, race, education level, marital status, household composition, employment status, and income.  This will help us target participants for studies that have specific eligibility requirements.

Only authorized staff at UCSUR will have access to the registry, which will be stored on secure, password protected computers.

At minimum, we would contact you approximately once per year to make sure your demographic information is up to date and that you wish to remain on the registry.  You may be contacted by phone, postal mail, or e-mail to participate in future studies.

Would you be willing to be included in the University Center for Social & Urban Research registry?
    
(please click either Yes or No)