Argosy University, Orange County
Informed Consent Form


Please read this consent agreement carefully before agreeing to participate in this experiment.


Purpose of the Study: This research study is being conducted by Kelsey Gruebnau, doctoral graduate student in Clinical Psychology at Argosy University, Orange County to explore relationship styles, attitudes, and experiences.


What you will do in this study: You will be asked to complete a couple brief questionnaires. This simply involves answering a series of questions. Questions will include details about your social memberships, demographics and your own personal views, feelings, and experiences with relationships.


Time required: The study will take approximately twenty minutes to complete.


Risks: There are minimal risks for participation in this study. This research study is designed to examine relationship styles rather than measuring your personality traits or intellectual abilities. However, you may feel some emotional discomfort when answering questions about your lifestyle, personal beliefs, or experiences.


Benefits: There are no direct benefits to participants. However, it is hoped that your participation will help researchers learn more about alternative relationships styles in order to better serve and understand the community. At the end of the study, you will be given the option to enter into a raffle to win a $50 gift card as a "thank you" for your participation.


Confidentiality: All information provided will remain confidential and will only be reported as group data with no identifying information. All the information gathered from the study, will be kept in a secure location and only those directly involved with the research will have access to them. After the research is completed, the information will be destroyed after a period of 3 years.


Participation and withdrawal: Your participation in this study is completely voluntary. You may withdraw from the study at any time without penalty and this will not affect your current or future relations with Argosy University, Southern California. You may withdraw by discontinuing the questionnaire at any time and your participation in the study will be stopped.
Researcher Contact: If you have any further questions about participating in this study, please contact me at (714) 620-3700 or kelsey.gruebnau@stu.argosy.edu.


Whom to contact about your rights in this experiment: This study is conducted under the supervision of Dr. Stephen Berger from Argosy University, Orange County, Department of Clinical Psychology. He may be contacted at (714) 620-3700 or stberger@argosy.edu. In addition, you may contact the Chair of Argosy University, Orange County, Institutional Review Board, Dr. Diana Siganoff. She may be contacted at 601 South Lewis Street, Orange CA 92868, (714) 620-3662, dsiganoff@argosy.edu.


Agreement: The purpose and nature of this research study has been explained to me by the researcher and I agree to participate in this study. I understand that I am free to withdraw at any time without any penalty or impact to my relationship with Argosy University, Southern California. I understand that I may print a copy of this consent document at this time or contact the researcher following completion of the questionnaire, in order to receive a copy of the document via e-mail for my own records, should I choose to do so.


ELECTRONIC CONSENT: Please select your choice below. You may print a copy of this consent form for your records. Clicking on the “Agree” button indicates that:

Question Title

  • You have read the above information.
  • You voluntarily agree to participate in this study.
  • You are 18 years of age or older.

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