1. Consent form

Question Title

* 1. Research Purpose
This study is designed to investigate the factors that influence one’s attitudes toward
marriage as well as one’s willingness to enter a marriage.

Description of the Research

I am a doctoral student currently conducting a study as a part of my course requirements. The study I am conducting is investigating marriage, romantic relationships and the factors that influence a person’s attitudes toward marriage. The study consists of approximately 100 multiple choice questions and it will take approximately 45 minutes to complete the entire study.

Potential Risks

This survey involves minimal risks to the participant, you may interrupt the survey at any given time without any consequences. The minimal psychological risks may include some negative feelings or memories of past romantic relationships and other experiences. If as a result of participating in this research study you experience any unpleasant psychological events and feel the need for counseling services, referrals are available and will be provided upon request via the primary researcher. Contact information is included on this consent form, which can be downloaded and printed.

Potential Benefits

Parcipation in this study may provide its participants with greater insight within their romantic


There will be no cost or compensation associated with participation in this study.

Additional Information

Participation in this study is completely voluntary. You may refuse to answer any question or withdraw from this study at any time if you become uncomfortable.

Contact Persons

If you have any questions, at any time, about this research, or want to discuss any
possible study-related injuries, please contact
Schenike S. Massie, MA at 862-224-3395 or schenikemassie045@yahoo.com.

Your identity as a participant in this research study will be kept confidential in any publication of the results of this study. By completing this survey you are agreeing to participate in the research. Please use care in choosing a secure environment to complete the survey because others around you may be able to view your responses.

The information obtained during this research (research records) will be kept confidential to the extent permitted by law. However, this research record may be reviewed by government agencies (such as the Department of Health and Human Services), the agency sponsoring this research, individuals who are authorized to monitor or audit the research, or the Institutional Review Board (the committee that oversees all research in human subjects at Adelphi University) if required by applicable laws or regulations, and the project’s principal investigators. The material will be maintained for up to 7 years.

Voluntary Participation

Participation in this study is voluntary. Any new information that develops during this study,
which might affect your decision to participate, will be given to you immediately.

Institutional Review Board Approval

This research has been reviewed and approved by the Adelphi University Institutional Review Board. If you have any questions, concerns or comments, please contact Drs. Michael O’Loughlin and Carolyn Springer, Co-Chairs of the Adelphi University IRB; respectively, 516 -877-4108, oloughli@adelphi.edu ; 516- 877-4753; springer@adelphi.edu .

Thank you for your time and participation in this research. If you have any questions at any time about this research or want to discuss any study related injuries please contact myself (below), or Dr. Rebecca Curtis at 516-877-4812, or Rcurtis.curtis@gmail.com


Schenike S. Massie, MA
Doctoral Candidate
Derner Institute