Consent Form


ST. FRANCIS COLLEGE 
INSTITUTIONAL REVIEW BOARD 
INFORMED CONSENT TO PARTICIPATE IN A RESEARCH STUDY 
 
 
Project Title: Long Term Negative Effects of Parental Divorce 
 
 
This is a research project being conducted by Danielle Cuellar at St. Francis College under the supervision ofDr.Wilson. Please read this form and ask any questions that you may have before agreeing to take part in this study. 
 
 
If you agree to be in this study, you will be asked to do the following:  
Complete the Demographics form, Experience in Close Relationships Scale-Short, the Parental Bonding Instrument, and the Lifespan Sibling Relationship Survey.  
 
 
The data collected will include no information that will make it possible to identify you without your permission.  To help protect your confidentiality, a code will be placed on the measures and other collected data.  
 
 
The risks in this study are minimal; your participation will require about 25 minutes of your time.  In terms of benefits, this research is not designed to help you personally, but the results may help the investigator learn more about the effects of parental divorce.  We hope that, in the future, other people might benefit from this study through improved understanding of the long term effects of parental divorce. 
 
 
Your participation in this research is completely voluntary.  You may choose not to take part at all.  If you decide to participate in this research, you may stop participating at any time.  If you decide not to participate in this study or if you stop participating at any time, you will not be penalized or lose any benefits to which you otherwise qualify.   
 
 
If you have any questions about the research study itself, please contact Danielle Cuellar at dcuellar2167@sfc.edu. You may also contact Dr. Karen Wilson (Thesis Advisor) at kwilson702@sfc.edu or the Chair of the Psychology Department, Dr. Kristy Biolsi, kbiolsi@sfc.edu.   This research has been approved by the St. Francis College Institutional Review Board at 180 Remsen Street, Brooklyn, NY 11201.
 

 
Statement of Consent 
I have read the above information.  I have asked questions and have received satisfactory answers.  I consent to participate in the study.  If you consent to participate please put your initials in the box below.

Question Title

* 1. Please put your initials in the box below if you consent to participate in this study. 

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