Study ID: HUM00102242
IRB: IRBMED Date Approved: 1/17/2019
Expiration Date: 1/16/2020
University of Michigan
Consent to Be Screened for Eligibility in a Research Study
Name of Study and Researchers
Title of Project: Project Amaze
Principal Investigator: Maureen Walton, PHD
You are invited to take a short survey to see if you qualify for a research study. The study will help us learn about ways to deliver wellness information in a way that is helpful to 16-24 year olds who use Facebook.
Before you can join the study, we will need to make sure you qualify. You must be between 16 and 24 years old. You will need to take a short survey that asks questions about where you live, your social media use and health behaviors, including alcohol use. These questions will take about 5 minutes to answer.
If you qualify to be in the study, we will ask for contact information so that we can send you a message with a link to more information about the study and another consent form. That form will explain the details of the rest of the study.
Taking this survey is voluntary. If you don’t want to take this survey, it won’t affect your Facebook access or account in any way.
There is no direct benefit to you for completing the survey. If you choose to take the survey, your answers will remain confidential and protected. Your answers to the survey will not be connected back to you unless you qualify for the study and give us your name.
Please check out our website for more information about the study: www.ProjectAmaze.org
Principal Investigator: Maureen Walton, PhD
Mailing Address: University of Michigan
2800 Plymouth Rd, NCRC – Bldg 16
Ann Arbor, MI 48109-2800
Telephone: 734-615-4225
Email: Amaze-Crew@med.umich.edu
Study Coordinator: Diane Schneeberger, LMSW
Mailing Address: University of Michigan
2800 Plymouth Rd, NCRC – Bldg 16
Ann Arbor, MI 48109-2800
Telephone: 734-615-4479
Email: Amaze-Crew@med.umich.edu
You may also express a concern about a study by contacting the Institutional Review Board:
University of Michigan Medical School Institutional Review Board (IRBMED)
2800 Plymouth Road
Building 520, Room 3214
Ann Arbor, MI 48109-2800
734-763-4768
E-mail: irbmed@umich.edu
If you are concerned about a possible violation of your privacy or concerned about a study, you may contact the University of Michigan Health System Compliance Help Line at 1-866-990-0111.
If you are concerned about a possible violation of your privacy or concerned about a study, you may contact the University of Michigan Health System Compliance Help Line at 1-866-990-0111.