Energy Drinks

Energy Drinks Consent Form

You are being asked to take part in a research study to determine how students feel about energy and their usage of them.
Please read this form carefully and ask any questions you may have before agreeing to take part in the study.

What the study is about:
What we will ask you to do: If you agree to be in this study, we will ask you to complete a survey. The survey includes questions about how you feel about energy drinks and how you use them. The survey takes about five minutes to complete.

Risks and benefits: The study will take place in any convenient place for the participant. It should take you approximately 10-20 minutes to complete the research study. Western Illinois University would like to learn more about students and their energy drink usage. No risks higher than a regular every day activity.

The answers to this research will be confidential. The records of this study will be kept private. Your answers will be recorded as a number. The data will be kept in Bree McEwan office in Memorial Hall 324. The data will be made available only to the persons conducting the research. No reference will be made in oral or written reports that could link participants to the research.

Taking part in this study is completely voluntary. You may skip any questions that you do not want to answer. If you decide to take part, you are free to withdraw at any time.

If you have questions: This project has been reviewed and approved by the WIU Institutional Review Board. Questions concerning your rights as a participant in this research may be directed to Jacqueline Thrapp, IRB Administrator, at (309) 298-1191 or The researchers conducting this study are Carla Mudd and Dr. Bree McEwan. If you have questions later, you may contact Carla Mudd at or at (309) 221-2789. You can reach Dr. McEwan at (309) 298-2370.

Statement of Consent: I have read the above information, and have received a copy of this form. I agree to participate in this study.

    This is a required question