UNIVERSITY OF CALIFORNIA IRVINE

CONSENT TO ACT AS A HUMAN RESEARCH SUBJECT

SALIENCE OF VISUAL PARTS

Professor Donald D. Hoffman

Department of Cognitive Science

949-824-6795

Adjunct Professor Co-Investigator

Dr. William R. Shankle

949-723-4106

Postdoctoral Researcher Co-Investigator

Dr. Junko Hara

949-824-3491

Graduate Student Co-Investigator

Colleen Nilson

949-824-6295

NAME OF SUBJECT:

PURPOSE OF STUDY:

I have been asked to participate in a research project designed to: understand how human vision represents visual objects.

PROCEDURES:

If I agree to participate, the following will occur: I will sit in front of a computer monitor for up to one hour in a session, at most one session a day, at most six sessions in a week, and for a total of at most six sessions. I will observe visual displays on the monitor, and press buttons to indicate what I see on the monitor.

RISKS: There are no known risks.

BENEFITS: There will be no direct benefit to subjects.

COST/COMPENSATION: Circle one: (a) I will receive course credit as compensation for my participation; (b) I will receive $10 per hour for participation; (c) I will receive no compensation.

OTHER CONSIDERATIONS:

I understand that any information derived from this research project that personally identifies me will not be voluntarily released or disclosed without my separate consent, except as specifically required by law.

If, during the course of this study, significant new information becomes available that may relate to my willingness to continue to participate, this information will be provided to me by the investigator.

I consent to participate in this study.

I understand that any information derived from this research project which personally identifies me will not be voluntarily released or disclosed without my separate consent, except as specifically required by law.

I have read this consent form and have been given a copy of it and Part II to keep. I consent to participate.

PART I OF II - SEE NEXT PAGE

SIGNATURE OF SUBJECT (age 7 and older) DATE

SIGNATURE OF PARENT/GUARDIAN DATE

SIGNATURE OF WITNESS DATE

SIGNATURE OF INVESTIGATOR DATE

CONSENT FORM - PART II

1. Participation in research is entirely voluntary. You may refuse to participate or withdraw from participation at any time without jeopardy to future medical care, employment, student status or other entitlements. The investigator may withdraw you at his/her professional discretion.

2. If, during the course of the study, significant new information which has been developed becomes available, which may relate to your willingness to continue to participate, this information will be provided to you by the investigator.

3. Any information derived from this research project that personally identifies you will not be voluntarily released or disclosed without your separate consent, except as specifically required by law.

4. If at any time you have questions regarding the research or your participation, you should contact the investigator who must answer all questions to the best of his/her knowledge. A telephone number is provided at the top of Part I of the consent form.

5. If at any time you have comments regarding the conduct of this research or questions about your rights as a research subject, you should contact the UCI Office of Research Administration, 152 Administration Building, Irvine, CA 92697-7600, (949) 824-6068 or (949) 824-2125.

For additional information regarding the items above, please telephone the IRB Administration Office at (949) 824-6068 or (949) 824-2125.

Subject's/Parent's/Guardian's Initials

Date

USE FOR BEHAVIORAL SCIENCES RESEARCH PROJECTS ONLY

Revised 2/97