SIMON FRASER UNIVERSITY
University Research Ethics Review Committee
FORM #4
SUBJECT FEEDBACK FORM - Optional

Completion of this form is OPTIONAL, and is not a requirement of participation in the project. However, if you have served as a subject in a project and would care to comment on the procedures involved, you may complete the following form and send it to the Chair, University Research Ethics Review Committee. All information received will be treated in a strictly confidential manner.

Name of Principal Investigator: Nora Boekhout

Title of Project:
The Integration of Computer Technology into the Curriculum at the Grade 4 and 5 Levels

Faculty: Education

Did you sign an Informed Consent Form before participating in the project? ____

Were there significant deviations from the originally stated procedures? _______
I wish to comment on my involvement in the above project which took place:
________________________________________________________________
(Date) (Place) (Time)

Comments: ______________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Completion of this section is optional

Your name: ______________________________________________________

Address: ______________________________________________________

Telephone: (w)_______________________ (h)_____________________

This form should be sent to the Chair, University Research Ethics Review Committee, c/o Office of the Vice-President, Research, Simon Fraser University, Burnaby, BC, V5A 1S6.