CONSENT FORM

You are invited to take part in a research study about counselors’ experiences working with refugee clients. The researcher is inviting professional counselors who have worked with at least one refugee client/student to be in the study. This form is part of a process called “informed consent” to allow you to understand this study before deciding whether to take part. This study is being conducted by a researcher named Shadin Atiyeh who is a doctoral student at Walden University. 
Background Information: The purpose of this study is to explore the perceptions of professional counselors related to their preparedness to demonstrate multicultural competence when counseling refugees.
Procedures: If you agree to be in this study, you will be asked to: Complete a demographic form that should take no more than 10 minutes, Participate in a face-to-face interview for no more than 60 minutes. You may use a pseudonym and participate by voice or chatbox only if desired, and Participate in a focus group of at least 5 participants for no more than 90 minutes. I will be providing a summary of the initial results at the focus group without any identifiable information. You will be provided with the focus group questions beforehand and may participate by voice or chatbox only if desired. You may also use a pseudonym. Here are some sample questions: Describe your experience working with refugees. What about your training or supervision prepared you for this work? What does multicultural competency to work with refugees mean to you? 
Voluntary Nature of the Study: This study is voluntary. You are free to accept or turn down the invitation. No one at Walden University will treat you differently if you decide not to be in the study. If you decide to be in the study now, you can still change your mind later. You may stop at any time.
Risks and Benefits of Being in the Study: Being in this type of study involves some risk of the minor discomforts that can be encountered in daily life, such as fatigue and loss of time. Being in this study would not pose risk to your safety or wellbeing. Participating in this study provides no direct benefit to the individual participants. The study may inform counselor education and supervision practices to better prepare counselors to work with refugee clients. Participating in the focus group will be online on Adobe Connect. You may participate with a pseudonym and choose not to share video. The researcher cannot guarantee that other participants in the group will maintain confidentiality and privacy and not repeat what was said in the focus group. and choose not to share video. The researcher cannot guarantee that other participants in the group will maintain confidentiality and privacy and not repeat what was said in the focus group.
Payment: You will receive a $15 Amazon gift card to communicate my appreciation for your time contributing to the study. You will receive it by email at the end of the face-to-face interview whether or not you continue with the study. You may withd

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* 1. Privacy: Reports coming out of this study will not share the identities of individual participants. Details that might identify participants, such as the location of the study, also will not be shared. The researcher will not use your personal information for any purpose outside of this research project. Data will be kept secure by storing names separately from the data on a password-protected laptop. Data will be kept for a period of at least 5 years, as required by the university. Those who participate in the focus group are asked to maintain confidentiality of participants’ identity if known and any topics discussed in the focus group. You may use a pseudonym in the individual interview and focus group and may participate by voice only or chatbox only if desired. The individual interview and focus group will be audio-recorded. 

Contacts and Questions: You may ask any questions you have now. Or if you have questions later, you may contact the researcher via shadin.atiyeh@waldenu.edu. If you want to talk privately about your rights as a participant, you can call the Research Participant Advocate at my university at 612-312-1210. Walden University’s approval number for this study is 02-13-19-0647540 and it expires on February 12th, 2020. 

Please print or save this consent form for your records. 

Obtaining Your Consent: If you feel you understand the study well enough to make a decision about it, please indicate your consent by continuing with the survey.

What is your email or phone number?

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* 2. Age & Gender:

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* 3. Preferred Pronouns:

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* 4. Race/Ethnicity

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* 5. Religious/Spiritual Background

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* 6. How many months of experience post-master’s graduation do you have in counseling?

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* 7. Describe your work setting in which you did so.

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* 8. Describe your educational experience.

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* 9. Please offer a time you would be available for a 30-45 minute interview (include time zone) and how would you like to be contacted. I will need your phone or email to contact you for the interview.  

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* 10. Please provide the contact information of another individual you know who may be eligible for the study.

If you would like a copy of the final results, please provide an email address for that purpose:

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