Research Participation Form

INTRODUCTION: You are invited to participate in a research study conducted at Pacific Lutheran University in the Psychology Department. The main investigator of the study is Dr. Michelle Ceynar, Associate Professor of Psychology. You were chosen to participate in the study because you are a student at Pacific Lutheran University. Approximately 500 participants will be enrolled in this study over the next 3 years. Participation should require about 10 minutes of your time. Participation is entirely voluntary; you may withdraw from the study at any time without consequences.

PURPOSE: The purpose of the study is to investigate students’ attitudes and behaviors with respect to alcohol consumption in college in order to assess the effectiveness of programming on campus that is intended to increase awareness about issues related to alcohol use by college students. You will not be identified in any of the results without your permission.

PROCEDURES: If you decide to participate in the study, you will be asked to complete a survey about your attitudes and behaviors with respect to alcohol consumption. Sample items from the survey are: “A college party is not a true college party without alcohol”; “I drink alcohol when I need to relax” and “Next time I drink alcohol I will ensure that my Blood Alcohol Concentration (BAC) stays below 0.08%.” You will also be asked to provide basic information about yourself such as whether you live on or off campus and how often you drink alcohol.

RISKS, INCONVENIENCES, AND DISCOMFORTS: It may be inconvenient for you to fill out a long questionnaire. Some of the questions on the survey may cause mild emotional discomfort. There is a potential risk for students who are minors of revealing underage drinking behavior which is illegal. **Because this survey is ANONYMOUS, researchers will be UNABLE TO IDENTIFY individuals who take the survey, therefore the risk is minimal.**

POTENTIAL BENEFITS: There are no major benefits to you for your participation, but a potential benefit may be that your responses may help improve programming and services available to students on campus.

CONFIDENTIALITY: Records of your participation in this study will be held confidential as far as is permitted by law. The case records from this study will be available for review by members of the Human Participants Review Board (HPRB) at Pacific Lutheran University. Individual participants’ data will be kept separate from identifying information in password protected storage to which only the researcher has access. Please note that due to the use of an online survey, there is a small chance that someone other than the researcher will be able to connect your identity with your data

You are encouraged to ask any questions, at any time, that will help you to understand how this study will be performed and/or how it will affect you. You may contact the principal investigator, Michelle Ceynar at (253)535-7297 or

If you have any questions or concerns about this study or your rights as a study participant, you may contact the Human Participants Review Board, Pacific Lutheran University through the Provost’s Office at (253) 535-7126.

Completing and submitting the questionnaire constitutes your consent to participate.

* 1. Do you agree to the consent information on this page?