Project Title: The Mental Health Differences for Female Rape Survivors when the Perpetrator is Criminally Punished as Opposed to not Criminally Punished

Principal Investigator: Dakota Conway, Delta State University

Faculty Co-investigator: Sally Zengaro, Delta State University

Affiliation: The McNair Scholars Program at Delta State University

The researcher requests your consent for participation in a study about the mental and physical health outcomes of rape victims whose attackers were criminally punished and rape victims whose attackers were not criminally punished. This consent form asks you to allow the researcher to use your survey responses to enhance understanding of the topic.

The survey asks about any physical or mental health symptoms that you have experienced. The survey also asks questions about other general information about your rape and questions about the criminal aspects of your rape.

Participation in this study is completely voluntary. If you decide not to participate there will not be any negative consequences. Please be aware that if you decide to participate, you may stop participating at any time, and your data will not be used for the survey.

Although participation in the survey can be beneficial, it also poses the risk of triggering traumatic memories. Thus, I encourage you to write down the link https://www.rainn.org/national-resources-sexual-assault-survivors-and-their-loved-ones for the Rape, Abuse & Incest National Network’s National Resources for Sexual Assault Survivors and their Loved Ones should you be unable to complete the survey. These resources are available to deal with the following: general information, child abuse/sexual abuse, incest, survivors with disabilities, college students, LGBTQ survivors, military resources, legal resources, medical/physical health, mental health, suicide and self-harm, and sexual assault prevention. This link will be given again at the end of the survey.

The survey could be completed in 5-10 minutes.

The researcher will maintain the confidentiality of the research records or data.

By submitting this form, you are indicating that you have read the description of the study and that you agree to the terms as described.

Thank you in advance for your participation!

If you have any questions about the study please contact Dakota Conway (dakotaconway48@gmail.com). If you have any concerns about the study, your rights or your treatment as a participant, please contact the Chair of the Institutional Review Board, Dr Beverly Moon at irb@deltastate.edu


 I agree to participate in the research study. I understand the purpose and nature of this study and I am participating voluntarily. I understand that I can withdraw from the study at any time, without penalty or consequences.

Question Title

* 1.  I agree to participate in the research study. I understand the purpose and nature of this study and I am participating voluntarily. I understand that I can withdraw from the study at any time, without penalty or consequences.

By answering yes, I acknowledge that the survey is intended for only women that have had one rapist and not multiple rapists.

Question Title

* 2. By answering yes, I acknowledge that the survey is intended for only women that have had one rapist and not multiple rapists.

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