Anonymous Survey Consent Form
You are invited to complete an anonymous survey for a Walden University doctoral study. To provide your informed consent, please review the information below and continue on to the survey if you choose to proceed.
Your role:
- Is completely voluntary and can end at any time you wish
- Is anonymous (your name will not be requested)
- Involves completing a questionnaire
- Involves little risk, but the questions could be upsetting. If distress arises, please contact the 988 Suicide & Crisis Lifeline by calling or texting 988.
Some example questions include:
- “I feel sad much of the time.”
- “I feel I am a total failure as a person.”
- “I have thoughts of killing myself.”
Privacy:
To protect your privacy, the researcher will not collect, track, or store your identity or contact info. In place of a consent signature, your completion of the questionnaire would indicate that you consent to your responses being analyzed in the study.
Data will be kept secure by using password-protected devices and platforms. Data will be retained for at least 5 years, as required by the university.
Once the doctoral student graduates, the study’s results will be posted online in Scholarworks (a searchable publication of Walden University research).
Contacts and Questions:
Questions about the study can be emailed to the student researcher via Jessica.lee8@waldenu.edu. If you want to talk privately about your rights as a participant or any negative parts of the study, you can call Walden University’s Research Participant Advocate at 612-312-1210 or email IRB@mail.waldenu.edu. Walden University’s ethics approval number for this study is 04-14-26-1177715.
You might wish to retain this consent form for your records. You may ask the researcher or Walden University for a copy at any time using the contact info above.