This activity is part of a research study conducted by Dr.
Matthew Huentelman at the Translational Genomics Research Institute
(or TGen) in Phoenix, Arizona.
The purpose of this research study is to understand the genetics
of how the human brain remembers things. Specifically, we
want to know how the way we remember things might change as we get
older. If we know the way people's memory changes when they get
older we may be able to understand what changes occur in people who
have a brain disease that affects their memory (like Alzheimer's
What will I have to do?
You will have to take three tests and then you will receive the
results of your tests. We would like to use the information
you provided and your test results to create a "Registry" or group
of people that we may contact again for future studies on
In some future studies, you may be asked to provide a saliva
sample. Dr Huentelman will get your DNA from your saliva.
DNA is a substance that is found in every cell in the human
body. Genes are part of DNA and are a "blueprint for life."
In future studies, Dr. Huentelman may look at your genes and
your testing results to understand more about memory.
In order to contact you for participation in
future studies, you will be asked at the end of this consent form
to provide your name and email address. Dr. Huentelman will
contact you through email to see whether you are interested in
participating in future memory studies. At that time, you
will be given a new consent form that will describe the new study
that is similar to this consent form.
How old do I have to be to participate?
You must be 18 years or older to participate in this
Are there any risks?
There are no physical risks involved in participating in this
study. Please keep in mind that you are free to end the study at
What do I get out of it?
You will receive feedback about the memory tests you
will take and how your results compare with other people who do
this activity. We will also explain what we hope to learn from this
research. The final results from this experiment will be posted on
the Results page.
Will I get paid and does it cost me anything to
There will be no cost to you if you participate in this study.
You will not be compensated for your participation in this
Will you share my information with other
We will not share any information that you give us. All of your
information is stored in a database. If you decide to give us your
name and email address, they will be stored separately from your
other personal data and test results. All of our databases are
password-protected and secure. No one can identify you without
access to both of these data sources.
What if I change my mind and don't want to participate
in the study anymore?
Your participation in this study is completely voluntary.
You may stop participation at any time during the research
activity. You can contact Dr. Huentelman at
firstname.lastname@example.org to withdraw from the study.
What if I have questions or
If you have any questions or comments about this activity, please
contact Dr. Matt Huentelman at email@example.com. Please go to
this web page to find
out more about the people involved in this research.
What if I have questions about my rights in this research, have
a complaint, or want to report a problem to someone besides the
If you have questions about your rights in this research study,
please contact: the Western Institutional Review Board
[360-252-2500] The WIRB is a group of people who protect the rights
of people involved in research studies.
For questions, concerns, suggestions, complaints that are not
being addressed by the research team, or in case of
research-related harm, please contact Stephanie Buchholtz in the
TGen Office of Research Compliance at firstname.lastname@example.org or
How do I agree to participate?
By ticking the box next to "I have read and understand...," you
are saying that: (1) You agree to take part in this research. (2)
You feel like you understand what is involved in this study.
(3) You understand that you are free to leave the study at
Will you contact me in the future?
You may be recontacted in the future through email to
participate in additional research studies. Participation in
future studies is completely voluntary.
I agree to take part in this research. I feel that I understand
what I am getting into, and I know I am free to leave the
experiment at any time.