UNIVERSITY AT BUFFALO, STATE UNIVERSITY OF NEW YORK
PAST SUCCESSES AND RELATIONSHIPS
INFORMATION SHEET

This research study has been reviewed and approved by the Social and Behavioral Sciences Institutional Review Board of the University at Buffalo, State University of New York. If you have any questions about your rights as a participant in a research project, or questions, concerns or complaints about the research and wish to speak with someone who is not a member of the research team, you should contact (anonymously, if you wish) the Social and Behavioral Sciences Institutional Review Board, 515 Capen, University at Buffalo, Buffalo, NY 14260, e-mail SBSIRB@research.buffalo.edu, phone 716-645-6474.

FOR QUESTIONS ABOUT THE RESEARCH, CONTACT: Dr. Jaye Derrick, Postdoctoral Associate, 453 Research Institute on Addictions, 1021 Main Street, Buffalo, New York 14203, 716-887-2218, jderrick@ria.buffalo.edu. This information sheet explains the research study. Please read it carefully. You may contact me to ask questions about anything you do not understand. If you do not have questions now, you may ask later.

PURPOSE: You are invited to participate in a study on past successes and relationships.

PROCEDURES: You will be asked to describe a personal goal. You will also be asked to answer questions about your goals and intentions in your relationship.

TIME COMMITMENT: Your participation in this experiment will take approximately 15 minutes.

RISKS AND BENEFITS: It is possible that some participants will be upset by the procedures. There may be no direct benefit to you other than the sense of helping the public at large and contributing to knowledge.

CONFIDENTIALITY: Your data will be collected anonymously. If you wish to participate in the drawing, you may enter your contact information into a form that is completely separate from the current study.

PAYMENT: Participants who complete the experiment will be eligible to participate in a drawing for the chance to win a $25 Amazon.com gift card. You are free to skip any questions that you do not feel comfortable answering. There is no penalty for skipping questions and you will still be eligible for the drawing.

JOINING OF YOUR OWN FREE WILL: Your participation is voluntary. Your refusal to participate will involve no penalty or loss of benefits to which you are otherwise entitled. You have the right to refuse to answer particular questions. You have the right to withdraw your data at the end of the session.

PARTICIPANT STATEMENT: I have read this information sheet. I have had all my questions answered to my satisfaction, and I voluntarily agree to participate in this study.

By clicking the “I accept” button and completing the survey, I demonstrate that I agree to the conditions in this information sheet. If I do not agree and wish to decline participation, I may click “I do not accept” below or simply close my browser.