Informed Consent

Hello, my name is Isabella Chen and I am a Social Science Research at Plainview-Old Bethpage JFK High School in Plainview, New York. Thank you for your interest in my research. I would like to study the social and emotional impacts of your educational experiences.

If you agree to participate, you will be asked to answer a few demographic questions first. Then, you will complete the Clance Impostor Phenomenon Scale (Clance, 1985), the Child - Adolescent Perfectionism Scale (Flett et al., 2016) and the School Burnout Inventory (Salmela-Aro et al., 2009).

All of your information will be kept confidential and your contact information will be coded by a third party assistant so the confidentiality of your survey will remain anonymous. All subject data will be stored on a password-protected computer. Although your IP address will not be stored in the survey results, there is always the possibility of tampering with an outside source when using the Internet for collecting information. While the confidentiality of your responses will be protected once the data is downloaded from the Internet, there is always the possibility of hacking or other security breaches that could threaten the confidentiality of your responses. Additionally, because the questions deal with personal information, some questions may make the respondent feel uncomfortable. If you wish to quit the study, simply exit the web page. Those partaking in this study will receive no direct benefit.

If you decide to participate, please answer all questions honestly. It will take you approximately 15 minutes to complete the entire study. If you have further questions about this study or would like verification of this study’s legitimacy, you may send an email to rtesar@pobschools.org and my research teacher will contact you.

Thank you for participating!


PLEASE NOTE: This Study is for Middle School Students only (6th, 7th, or 8th). Additionally, this study can only be completed once. You can not take is again your following school year.

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* 1. Please type the following into the text box below to give your consent to participate: “I agree to participate in this study.”

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* 2. Please attest that you have not completed this study before.

I have not taken this study before.

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