STATEMENT OF INFORMED CONSENT
-----------------------------

A group of students in the User Interface Design and Development class
at the School of Information at UC Berkeley are conducting studies to
understand XXX.

If you volunteer to participate in this study, you will be asked to
perform some tasks related to XXX, and to answer some questions.  Your
interactions with the computer may also be digitally recorded on
video, audio and/or with still photographs.

This research poses no risks to you other than those normally
encountered in daily life.  All of the information from your session
will be kept anonymous.  We will not name you if and when we discuss
your behavior in our assignments, and any potential research
publications.  After the research is completed, we may save the
anonymous notes for future use by ourselves or others.

Your participation in this research is voluntary, and you are free to
refuse to participate or quit the experiment at any time.  Whether or
not you chose to participate will have no bearing in relation to your
standing in any department of UC Berkeley.  If you have questions
about the research, you may contact Professor Tapan Parikh at
510-642-4583, or by electronic mail at parikh@ischool.berkeley.edu.
You may keep a copy of this form for reference.

If you accept these terms, please write your initials and the date
here: 

INITIALS	___________________

DATE		___________________