UNIVERSITY OF MASSACHUSETTS LOWELL

Institutional Review Board

Informed Consent Form

Date Prepared/Revised: September 30, 2002

Project Title: “Taste of Synthetic Flavor-Enhanced Foods”_______________________________________

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Researcher(s): Sally Jones________________________________________________________________
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APPROVED FOR USE BY THE UNIVERSITY OF MASSACHUSETTS LOWELL INSTITUTIONAL REVIEW BOARD.

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Signature of IRB Chairperson Date of Approval

This Informed Consent Form is valid for a period not to exceed one year from the date of the approval appearing above.

Purpose

You are being asked to participate in a research study which involves tasting of food. Food processors are interested in determining how natural flavor is affected by the addition of synthetic sweeteners. The only way to know how people perceive a taste is to actually have them taste a food and give their reaction.

Procedure and Duration

You are being to asked to participate in tasting food on two different days that are at least seven days apart. Each food tasting will last about ten minutes, after which a ten-minute written questionnaire will need to be completed. You will be asked not to eat for at least two hours preceding the tasting.

Risks and Discomfort

There are no significant risks involved in being a participant in this study, though some people may be allergic to certain foods or artificial sweeteners. Not everybody likes the same foods or has the same taste, so there is a slight possibility of stomach distress. If this should occur, it would be of a short duration. You will be asked to sign a simple release form on the two days of the tasting, indicating you are in good health on those days and listing any foods or sweeteners for which you have a known allergy. There is a risk of disclosure as a result of your participation in this study.

Benefits

Participation in this study, “Taste of Synthetic Flavor-Enhanced Foods,” will entitle you to be paid $10.00 for each of the two tastings. There is no other benefit, other than the knowledge that you will be helping to bring better products to the marketplace.

Refusal or Withdrawal of Participation

Participation in this study is completely voluntary, and your participation or non-participation will not affect other relationships (e.g., employer, school, etc.). You may discontinue your participation in this research program at any time without penalty or costs of any nature, character and kind.

(SAMPLE FORM ONLY)

Informed Consent Form (continued) Page 2 of 2

Project Title: “Taste of Synthetic Flavor-Enhanced Foods”_______________________________________

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Privacy and Confidentiality

Every precaution shall be taken to protect your privacy and the confidentiality of the records and data pertaining to you in particular and the research program in general, disclosure of which may contribute to identifying you specifically to persons not related to this research program. Examples of precautions to be taken would be: destruction of raw data, removal of identifiers linking subject to data, etc. Audio/video tapes will be destroyed at the end of three years.

Additional Information

If you do not understand any portion of what you are being asked to do or the contents of this form, the researchers are available to provide a complete explanation. Questions relating to this research project are welcome at any time. Please direct them to Sally Jones, the Researcher, or Dr. Sam Phillips, the Faculty Advisor, at the following addresses/telephone numbers:

Sally Jones Dr. Sam Phillips

11 Main Street Dept. of XXX

Lowell, MA 01852 East Campus, Merrimack Hall, Room 316

Home Tel. # 978-555-9964 University of Massachusetts Lowell

Daytime Tel. # 978-453-0000 Lowell, MA 01854

Campus Tel. # 978-934-0000

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Researcher(s) Date Faculty Advisor (if applicable) Date

[Every individual listed as a Researcher must sign this form.]

I have been informed of any and all possible risks or discomfort.

I have read the statements contained herein, have had the opportunity to fully discuss my concerns and questions, and fully understand the nature and character of my involvement in this research program as a participant and the attendant risks and consequences.

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Research Participant Date Parent or Guardian/Legal Representative Date

(if applicable)

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Agency Official (if applicable) Date

2002-03 form