Adelphi University
Informed Consent Form
Please Read Carefully Before Consenting

The study: I am invited to take part in a study, “Relationship Quality and Academic Performance” The study is being conducted by Jennifer Huntley who is the principal investigator, and by Professor Lawrence Josephs, co-investigator. Jennifer Huntley may be reached at (347) 829-1053 or at  Co-investigator, Dr. Lawrence Josephs, can be reached at (516) 877-4814 or at

Purpose: The study is designed to see if academic performance is affected by relationship quality and the personality variables that are associated with relationship satisfaction.

Procedures: If I agree to participate in this study, I will be asked to do the following: fill out a questionnaire about my demographic information, of my own relationship, and my own academic performance.

Benefits: I will receive no direct benefits from participation in this study.
Risks: There are minimal risks associated with this study. The questionnaires ask personal questions about my feelings and relationships, which may be uncomfortable for me. I will be able to ask questions, before or after the study, by emailing the investigator and co-investigator at and  If any unpleasant psychological events occur, the investigators will be able to provide participants with information as to sources of mental health assistance.

Confidentiality: The data for this study is collected via an online service called Survey Monkey, and is therefore electronic. All electronic records will be erased after 7 years. None of my professors will be able to access my responses, and the content of my responses will not influence my academic evaluation in any way. My information will be strictly confidential. The Survey Monkey default settings will be set so as to not collect IP addresses. There is, however, a limit to the confidentiality that can be guaranteed due to the nature of online data collection. As with any information collected online, no guarantees can be made regarding the interception of data sent via the Internet by any third parties. Moreover, 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.

Consent: Participation in this study is voluntary. Non-participation or withdrawal will not affect my grade or academic standing. I may withdraw from the study at any point during my participation.

Estimated time commitment: 20-30 minutes.

The investigator and the above have informed me about this study and answered my current questions to my satisfaction. Therefore, I agree to participate in this study. If I have any additional questions I may contact the principal investigator, Jennifer Huntley, or co-investigator, Dr. Lawrence Josephs. I may print a copy of this consent document to keep.
This research has been reviewed and approved by the Adelphi University Institutional Review Board. If you have any questions, concerns or comments, please contact the IRB chair, Dr. Carolyn Springer, 516-877-4753;

* 1. To indicate your consent, please select the yes button as listed below. After completed, you will be directed to a separate survey.

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