Informed Consent

Teachers College, Columbia University
525 West 120th Street
New York NY 10027
212 678 3000

DESCRIPTION OF THE RESEARCH: You are invited to participate in a research study on the mental health effects of perceived racial-ethnic discrimination among Latino/a adults. You will be asked to answer a series of questions regarding your experiences of racial-ethnic discrimination and the stress associated with these experiences. In addition, you will be asked a series of questions regarding mental health functioning. This study consists of one online survey and will be conducted by Carrie Muchow, Ed.M. This study has been approved by the Teachers College, Columbia University IRB Protocol # 12-323.

RISKS AND BENEFITS: The risks associated with this study are expected to be minimal. If you encounter discomfort while responding to any of the questions please feel free not to answer the questions or to discontinue your participation at any time. Upon completion of the study, you will be provided with information about various organizations that focus on some of the issues that may arise for you in your completion of this study. If you have any questions or concerns, feel free to contact the principal investigator. While there are no direct benefits to participating in this study, findings of this research will have implications for improving mental health service delivery to Latino/a adults.

PAYMENTS: There will be no payment for participation in this study.

DATA STORAGE TO PROTECT CONFIDENTIALITY: You will not be asked to provide your name or any contact information during this research study. All identifying information that you provide will be kept private and confidential. Each completed survey will be numerically coded to further ensure anonymity. The data will be temporarily stored on SuveryMonkey ( until data collection is completed. At that time, the numerically coded data will be downloaded to a password protected computer. The password will only be known to the principal investigator. When analysis of the data is complete, the data will be stored in a locked file cabinet and will be destroyed after 5 years.

TIME INVOLVEMENT: Your participation will take approximately 15 - 30 minutes.

HOW RESULTS WILL BE USED: The results of this study will be used to inform my research competency project requirement. I am examining perceptions of racial-ethnic discrimination, the stressfulness of these encounters, and implications for mental health and well-being. It is possible that the results may be utilized for future educational purposes including publications and/or conference presentations.