Consent Form for Participation in a Research Project
University of Saint Joseph
Department of Psychology
1678 Asylum Avenue
West Hartford, CT 06117
1) Principal Investigator: Kristin Henkel Cistulli, PhD
kcistulli@usj.edu
860-231-5437
2) Student Researcher: Erion Jones
erionjones@usj.edu
3) Study Title: Preferences in Mental Health Professionals
4) Invitation to participate: As members of USJ’s Department of Psychology, we are conducting a research study on therapist preference. We are asking you to participate in the study.
Your participation in the research study is voluntary. Before agreeing to be part of this study, please read the following information carefully. Feel free to call or email with questions if you do not understand something.
5) The purpose of this research study is to determine whether certain people have preferences if given the choice to select their own therapist.
6) This experiment will consist of an online survey. You will be asked about your demographic information such as age and ethnicity. You will be asked to answer questions about your preferences in mental health professionals.
7) Risks to participants in this study are minimal. One potential risk is the possibility of feeling uncomfortable being asked about gender identity, race, and sexual orientation. An inconvenience is the time it takes to participate in the study which is less than ten minutes.
8) There are no benefits to you personally. The survey will provide information to the researcher about people's preferences in mental health professionals.
9) All information that you provide as a part of this study will be completely anonymous. The data collected could be used in a formal paper and project related to the research, but the data you provide cannot be connected to your identity in any way. You should be aware that the University of Saint Joseph Institutional Review Board may inspect study records as part of its mission to protect the safety of research participants.
10) Your participation in this study is entirely voluntary. You may refuse to participate in this research. Such refusal will not have any negative consequences for you. If you begin to participate in the research, you may at any time, for any reason, discontinue your participation without any negative consequences.
11) Contacts for Additional Information: If you have further questions about this research project, please contact the principal investigator, Kristin Henkel Cistulli, at (860) 231-5437 or kcistulli@usj.edu. If you have any questions about your rights as a research participant, please contact the University of Saint Joseph Institutional Review Board (IRB) at 860-231-5802. The IRB is a group of people that reviews research studies and protects the rights of individuals who agree to participate in research studies.
12) By checking “I Agree” below, you acknowledge that you have read this information and have had the study purposes, procedures, risks, and benefits explained to your satisfaction. It indicates your informed consent to participate in the study.