Flu Vaccine Campaign

WIU Flu Vaccine Campaign


You are being asked to participate in a research study about your personality. The purpose of this research is understand what kinds of people are able to convince others to adopt healthy behaviors.You were selected as a possible participant because you are a Western Illinois University student.  Please read this form and ask any questions that you may have before agreeing to be in the research. You must be 18 years old to participate.

[Information about Participants’ Involvement in the Study]

The study is an online survey. It should take you approximately 4 minutes to complete this part of the research study.

If you agree to be a participant in this research, we would ask you to do the following things: answer some questions in an online survey about your personality and then read about an opportunity to join a flu vaccine promotion campaign


This research has the following risks:  no risk beyond daily living.

The benefits of participation are that you may benefit from learning about flu vaccines and promotions of health behaviors

You will receive the following payment/reimbursement:  You will receive a chance to win $100 in a raffle. If you decide to volunteer for the flu vaccine campaign, you could potentially win more money (detailed in the survey). You are responsible for any taxes if you win any money.

The information in this research will be kept confidential. Your name will not be associated with this set of data unless you volunteer for the campaign. You will be asked to complete a separate form at the end of the survey where you will indicate your contact information. Research data will be stored in a secure location: the primary investigator’s password protected office computer. The data will be anonymized and made publicly available. No reference will be made in oral or written reports that could link participants to the research.

[Voluntary Participation]

You do not have to perform any activity you do not want to. You do not have to answer any question you do not want to answer. Participation in this study is voluntary. If you decide to participate, you may withdraw from the study at anytime without penalty and without loss of benefits to which you are otherwise entitled.

Contact Information:

If there are any questions at any time about the study or the procedures, or you experience adverse effects as a result of participating in this study, please contact:

Prof. Christopher J. Carpenter

Communication Department

(309) 298-1622


This project has been reviewed and approved by the WIU Institutional Review Board. Questions concerning your rights as a participant in this research may be directed to IRB Administrator, at (309) 298-1191 or IRB@wiu.edu.


I have read the above information, and I have received a copy of this form. I agree to participate in this study. Please click continue below