INFORMED CONSENT FORM

Consent to Participate in a Research Study

Title of Research: Correlational Study on the Level of Perceived Loneliness to Suicidal

Ideation of Selected College Students of Cebu Doctors’ University

Investigator: Lorenz Moises Enrick S. Binghay (0942-014-6499) & Jason R. Casanova (0943-611-
7005), College of Arts and Sciences, Psychology Department

Purpose and Background: The purpose of this study is to determine the correlation of the
Interpesonal Orientation and Hypercompetitiveness of second and third Year College of Allied
Medical Sciences students.

Procedure: If I agree to participate, the following things will happen:

1. I will have to sign a consent form indicating that I agree to participate.

2. I will have to answer a 15-item scale that measures a person’s level of Interpersonal Orientation.
This will take 10 minutes.

3. I will have to answer a 26-item inventory to assess my suicide ideation. This will take 5 to 10
minutes.

Benefits: There may be no direct benefit to me from participating in this study. However, I may find
out my level of Interpersonal Orientation and Hypercompetitiveness.

Risks: There may be no direct risk to me from participating in this study.

Confidentiality: All information obtained in this study will be considered confidential and used only
for research purposes. My identity will be kept confidential in so far as the law allows. Once research
has been approved after oral defense, the results will be burned.

Questions: LORENZ MOISES ENRICK S. BINGHAY and JASON R. CASANOVA, the researchers has
discussed this information with me and offered to answer my question, I can contact them at 0942-
014-6499 and 0943-611-7005.

Right to Refuse or Withdraw: My participation in this study is entirely voluntary, and I am free to
refuse to take part or withdraw at any time without any consequences.

Consent: I agree to participate in this study. I have been given a copy of this form and had a chance
to read it.

Signature of Participant: Date Signed:

_______________________________ ____________________________________

Signature of Investigator/Witness: