Participant Researcher Agreement (Form)

Page 1

Study: The Texas Freedom Colony Project: Ethnographic Study and Mapping of Informal Communities & Grassroots Preservation Practices

UVA IRB-SBS # 5460

Adopt-A-County Volunteer Program

Participant Researcher Consent & Notification of Compensation Form

You are invited to participate in a research study, "The Texas Freedom Colony Project: Ethnographic Study and Mapping of Informal Communities & Grassroots Preservation Practices,” by Dr. Andrea Roberts of the SCHOOL OF ARCHITECTURE at the UNIVERSITY OF VIRGINIA, [Dr. Andrea Roberts, School of Architecture, Urban and Environmental Planning Program, Campbell Hall, Room 320, PO Box 400122, Charlottesville, VA 22904, 434924-6445, Email address:, UVA IRB-SBS # 5460 ] This research project prioritizes involvement and data collected from freedom colony descendant communities. This form explains forms of compensation available to PARTICIPANT RESEARCHERS and consent on behalf of the PARTICIPANT RESEARCHER. This document also ensures that The Texas Freedom Colonies Project ( TxFCP) upholds the highest ethical, cultural, and scholarly principles by outlining expectations of PARTICIPANT RESEARCHERS and the TxFCP during the study.

The Adopt a County Volunteer Program is part of a broader research study about the cultural phenomena freedom colonies. Your involvement as a PARTICIPANT RESEARCHER in the study will contribute to a better understanding of how to identify settlements, create virtual archives, and help communities achieve their community development and historic preservation goals. No special approval or training is required to participate other than that provided at the beginning of each survey form.

PARTICIPANT RESEARCHERS participate in engaged, community-based research. Collaborative, communitybased research endeavors offer benefits to:

1. Researchers through long-term community labs that support evidence-based, project-driven, and innovative approaches for students and faculty.

2. Community partners through training on planning and preservation issues and research methods Consent

PARTICIPANT RESEARCHERS co-lead and co-plan educational workshops and symposia where the public is trained and descendants network with one another to share resources and knowledge about freedom colonies. The PI consults with PARTICIPANT RESEARCHERS to coordinate opportunities to collect data at their events and in their communities.

As a PARTICIPANT RESEARCHER, you understand and agree to the following:

 You must be at least 18 years old to participate.

 Signing this form grants consent to use data (image, audio, video, written comments, and field notes) related to involvement in the study as a PARTICIPANT RESEARCHER.

 The activities may or may not take an hour of additional time (i.e. phone interview). Participant researchers can provide as little or as much time and information as they desire.

 Training is required for PARTICIPANT RESEARCHERS. They must meet with the PI or research staff to learn data collection and consent protocols by shadowing them during TXFC Project workshops. Workshops and events will be co-led (with the PI and student researcher) by existing volunteers ( who have already been active with the Freedom Colonies Project for over 2+ years).


Information We Receive from You

Follow-up information on the volunteer experience and participation may be requested. As a Texas Freedom Colonies Project Survey user, we collect your personal information such as your name and email, when you fill out the form. This information is optional and will be used for our internal record keeping, and we may use this information to improve our database and services and feature contacts. However, the zip code associated with your current residence address is required. We need this information to keep track of the geographical distribution of our users. We will not share this information with any third party. When you upload data to The Texas Freedom Colonies Project (for example, via survey forms or our website), you give the project research team(and those we work with) a worldwide license to use, host, store, reproduce and modify such uploaded data for the purpose of researches and presentation in the Texas Freedom Colonies Atlas web map services. Make sure you have the necessary rights to grant us this license before uploading materials. The files and data you upload may be used under Attribution-Noncommercial-NoDerivs CC BY-NC-NDlicense. We may share them with others for presentations, analysis, publications, and online mapping services, but you will always be given credit for your data.


Compensation is available to Participant Researchers

 PARTICIPANT RESEARCHER. You may be compensated for travel and expenses up to $200 during the duration of the study if you are volunteer using gift cards amounts. Prior approval from PI is required.

 Whenever providing expertise in the form of a workshop or event creation, stipends to compensate for time and expertise provided will be issued at a rate of $75/hr., capped at $2,500 throughout the grant–funded project duration unless under contractual or grant obligations to pay more through UVA issued checks.

 Guest speaking and event co-planning for more than 50 percent of event proceeds will also be compensated or funded at a rate of $500 per event.

 Funding for event materials that support research and guest experts that prepare attendees or research participants who act as keynote speakers are also funded.

 Participants’ social security numbers are collected for tax purposes (for payments over $100 per year).

Risks/Benefits/Confidentiality of Data

There are no known risks associated with your participation. There will be no costs for participating. Your name and email address will be kept during the data collection phase [for tracking purposes only]. However, those of the residents you work with will not be kept or tracked. Identifying information will be stripped from the final dataset associated with surveys.

Participation or Withdrawal

Your participation in this study is voluntary. You may decline to answer any question and have the right to withdraw from participation at any time. You may also be audio recorded. However, participants must give verbal consent to being audio recorded. You may decline to be audio recorded at any time. Withdrawal will not affect your relationship with the University of Virginia. To withdraw from the study, tell us you want to withdraw your study entry or related materials from the study in an email. Indicate in the email that you want to refrain from


participating. You can withdraw from the study while completing surveys by simply stopping participating or closing the browser window. If you do not want to receive any more reminders, you may email us at or If you have any questions about the study or need to update your email address, contact the PI.

To obtain more information about the study, ask questions about the research procedures, express concerns about your participation, or report illness, injury, or other problems, please contact:

Tonya R. Moon, Ph.D. Chair, Institutional Review Board for the Social and Behavioral Sciences One Morton Dr Suite 400 University of Virginia, P.O. Box 800392 Charlottesville, VA 22908-0392 Telephone: (434) 924-5999

Email: Website: Website for Research Participants:

You will receive a copy of this consent for your records.

To consent & confirm you understand the compensation policy, sign here: ________________________________________________

Print Name:______________________________________

Email: __________________________________________

Phone (optional): ____________________________


To consent to being a PARTICIPANT RESEARCHER, sign here: ________________________________________________

Print Name:______________________________________

Email: __________________________________________

Phone (optional): ____________________________


Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.