As part of a research project on Healthy Communities, we are making a photographic of the operations you perform with one or more interfaces to computer systems.� We would like you to indicate below what uses of these records you are willing to consent to.� This is completely up to you.� We will only use the records in ways that you agree to.� In any use of these records, your name will not be identified.�
Please initial all those statements that you agree to.
The records can be studied by the research team for use in
research reports. _____
The records can be shown to subjects in other experiments.
_____
The records can be used in scientific publications. ______
The records can be shown at meetings of scientists interested in the study of human-computer interaction and information access.� _____
The records can be shown in public presentations to nonscientific groups. _____
I have read the description and give my consent for the use of the records as indicated above.
Name (printed):� ______________________________
Signature: ___________________________________ Date
_______________________