Educational Intervention Study Consent Form

Study Title

Principal Investigator

Purpose of the Study

Procedures

Benefits

Risks

Confidentiality

Voluntary Participation

Contact Information

Consent Statement

I have read and understood the information provided above. I have had the opportunity to ask questions about the study and my participation. I voluntarily agree to participate in this study.

Participant Name Participant Signature Date

Investigator Name Investigator Signature Date