INFORMED CONSENT

You are requested to be part of a research study being conducted by names of the student researchers, BS

Psychology students at Adamson University. The purpose of the study is to _________. Your participation in

this study is an affirmation that you are at least 18 years of age, currently enrolled as a college student this

semester (AY 2020-2021) and <Kindly insert the other criteria or qualifications that your research participants

must meet. Example: you have siblings, currently taking an Engineering course, etc.>, and that you agreed to

answer a (Kindly indicate the number of pages)-page questionnaire for approximately <insert the time period>.

In this study, you will <indicate the research procedure>. By participating in this study, you acknowledge

that some statements or procedures may potentially elicit minimal emotional discomfort that has no anticipated

long-term risks to you. You also acknowledge that your participation is considered a contribution to a body of

knowledge about (insert research area of interest). You may indicate here if you will provide a token of

participation or not.

Your participation in this research is entirely ANONYMOUS which means that any of your responses and

non-identifiable demographic information will NOT be associated with your identity. You may indicate here

how you will keep the data confidential (e.g., the data will be stored in a password protected file). Kindly

refrain from putting your name or any identifying information on any section of the questionnaire. Your

decision to participate in this research is VOLUNTARY. You may decline to take part in or withdraw from

this research at any time without penalty or consequences. If you decide to withdraw, your responses will not

be included in and used for the analyses of data and interpretation of results, respectively.

If you have questions, clarifications, and/or comments about the study or your rights as research

participant, please feel free to get in touch with GROUP MEMBER at INSTITUTIONAL EMAIL ADDRESS.

Thank you!

Statement of Consent:

I have read the above information and I understand the study well enough to make a decision about my

involvement. By signing below, I am agreeing to the terms described above (for online administration, you may

opt to use statements such as, “By clicking the “NEXT”, “I AGREE”, or “OK” button).

__________________________ __________________________
Signature over Printed Name Date