Consent Form

Parents and College Students affected by suicide are invited to participate in a national survey on college student suicide.  Conducted under the direction of John T. Chirban, Ph.D., Th.D, Harvard Medical School, this study is designed to understand causes of college suicide and better methods for prevention of college suicide.

Your participation in this research study is voluntary. If you decide not to participate in this survey, you may withdraw from participation at any time for any circumstance.

The procedure involves filling out an online survey that will take approximately 15-20 minutes. Your responses will be confidential and we do not collect identifying information such as your name, email address or IP address.

The results of this study, including the information you provide and in some cases your exact responses, may be used by Dr. Chirban in his research and analysis on this important topic, and may be referenced in upcoming episodes of the Dr. Phil show or in a book on this topic by Dr. Chirban  (which is not affiliated with the Dr. Phil show).

Question Title

* 1.
ELECTRONIC CONSENT: Please select your choice below.
Clicking on the "Agree" button below indicates that: 
• you have read the above information
• you voluntarily agree to participate
• you are at least 18 years of age 

If you do not wish to participate in the research study, please decline participation by clicking on the "Disagree" button below.