Cheese Alive! Project Consent form and Questionnaire
Cheese Alive! Informed Consent Form
North Carolina Central University
INFORMED CONSENT FORM for RESEARCH
This form, IRB number 1201353, is valid August 2017 to July 2018.
Title of Study: Cheese Alive!

Principal Investigator:
Julie Horvath, Ph.D. Jointly Appointed
Department of Biology Nature Research Center
2251 Mary Townes Sciences Complex Genomics & Microbiology Research Lab
North Carolina Central University NC Museum of Natural Sciences
Durham, NC 27707 Raleigh, NC 27601
(919) 530-6248 (919) 707-8242
jhorvath@nccu.edu Julie.Horvath@naturalsciences.org

Your participation in this study is voluntary. You have the right to be a part of this study, to choose not to participate, or to stop participating at any time without penalty. If you choose to participate in this study, you will be one of up to 1000 people who will participate. Details about this study are discussed below. It is important that you understand this information so that you can make an informed choice about whether you want to participate in this research.

Purpose
The purpose of this study is to learn about how a person’s food preference is impacted by their ethnicity and the microorganisms living in dairy products.
Duration and Location
The study will be conducted at NC Central University in Durham, NC, NC State University in Raleigh, NC, or at the NC Museum of Natural Sciences in Raleigh, NC, or through online surveys open to the public. The survey will be a one-time survey that will take less than one hour to complete.
What will happen if you take part in the study?
If you agree to participate in this study, you will be asked to participate in the following:

Complete a questionnaire about your dietary habits, food preferences and your country of origin. At the NC Museum of Natural Sciences, participants may be offered the chance to smell or taste samples blindly to identify types of cheese or other foods, or taste test strips and answer questions.


Risks
There are no expected risks associated with this study. While the investigator will maintain confidentiality of the study records to the full extent allowed by law, there is always risk that information obtained via online surveys might be breached. If you choose to taste food samples as part of this study, you risk symptoms of food allergies or food intolerances you might have.

Benefits and Payment
You will not receive any direct benefit from participating in the study. As a subject in this study, you have the potential to benefit society by contributing to generalizable knowledge of human nutrition.


Right to Refuse or Withdraw from the Study
Your participation in this study is voluntary. You may refuse to participate or may discontinue your participation at any time without penalty. The Investigator has the right to stop your participation at any time.
Privacy and Confidentiality
The information in the study records will be kept confidential to the full extent allowed by law. Data will be stored securely in a database inaccessible to outsiders. Signed and completed forms will be kept in a locked filing cabinet in Dr. Horvath’s office at NC Central University or the NC Museum of Natural Sciences. Participants will not be identified in any report or publication.
Compensation
You will not receive anything for participating.
Questions about the Study
If you have any questions, complaints or concerns about this study, you may contact the Principal Investigator listed on the first page. This study has been approved by the Institutional Review Board (IRB) at North Carolina Central University. If you have questions about your rights as a research participant, or if you have complaints or concerns about this study, you may contact the IRB Chair at IRB@nccu.edu or 919-530-5105, or the Director of Research Compliance, uhoffler@nccu.edu, 919-530-5140.

Consent To Participate
“I have read the information provided above and voluntarily agree to participate in this study. My signature certifies that I am 18 years of age or older. I have received a copy of this form. I agree to participate in this study with the understanding that I may choose not to participate or to stop participating at any time without penalty or loss of benefits to which I am otherwise entitled.”

Title of Study: Cheese Alive!
Principal Investigator: Julie Horvath, PhD

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