DEPARTMENT OF CORRECTIONS

RESEARCH CONSENT FORM

I freely and voluntarily agree to particpate in the research project entitled

________________________________________________________________.

I fully realize that my participation is of my own choosing and I agree not to hold the

Department of Corrections responsible for any personal injury to myself and release any claim

against the Department of Corrections pertaining to the research project.  The project has been

satisfactorily explained to me and all my questions have been satisfactorily answered.

_______________________________________          _____________________________

Signature of Participant                                                    Date

_______________________________________         _____________________________

Signature of Witness                                                       Date