UNIVERSITY OF CALIFORNIA, BERKELEY



UNIVERSITY OF CALIFORNIA, BERKELEY

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EXPERIMENTAL SOCIAL SCIENCE LABORATORY

Social Science Matrix

Appendix VI

Sample Debriefing Form

This study focuses on _________________ (state nature and purpose of study).

In this study, we did not informed you that ______________ (state describe what information was withheld from subject). Withholding this information was necessary for us to better understand _____________ (explain why the omission was necessary). Therefore, we apologize for not telling you, but feel it was necessary for us to examine the processes in this study.

Now that you understand the true nature of our study, we would like to give you the chance to refuse the use of your data for our research purposes. You are free to ask us not to use your data in our study analysis. If you decline to let us use your data, you will still receive full payment just as you would if we use your data in our analysis. This is entirely voluntary, but we hope to analyze the data to better understand __________ (explain the purpose of the study).

Because this experiment is ongoing, we request that you not share the true nature and purpose of this experiment with others who might potentially participate in our study.

If you have any questions about this research you may contact me, NAME OF LEAD INVESITGATOR, at (510) ###-#### or by email at email here . If you agree to allow us to use the data, please sign this form below.

If you have any questions regarding your treatment or your rights as a participant in this research, please contact the University of California, Berkeley Committee for the Protection of Human Subjects at (510) 642-7461 or subjects@berkeley.edu

I certify that I am 18 years or older. I have read this debriefing form and I agree to allow the use of my data for research purposes.

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|Signature | |Date |

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|SANTA BARBARA ( SANTA CRUZ |

|BERKELEY ( DAVIS ( IRVINE ( LOS ANGELES ( RIVERSIDE ( SAN DIEGO ( SAN FRANCISCO |

| |

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Professor Don Moore, Director

Haas School of Business

F565 Haas School of Business

Berkeley, CA 94720-1900

Tel: (510) 642-1059

dm@berkeley.edu

Mailing Address:

EXPERIMENTAL SOCIAL SCIENCE LABORATORY

Social Science Matrix

Hearst Memorial Gym, Suite 2

Berkeley, CA 94720

Rowilma del Castillo, Manager

Hearst Memorial Gym, Suite 2

Berkeley, CA 94720

Tel; (510) 642-4159

rowilma@haas.berkeley.edu

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