Informed Consent Form for Participation

* 1. This is to certify that I agree to participate in research as part of an authorized research program of the University of Central Oklahoma, under the supervision of Dr. Alicia Limke. The purpose of this study is to examine how polyamorous relationships can meet emotional and romantic needs. I understand that I will answer a variety of questions toward this goal, including describing my feelings and opinions and providing demographic information.

If I have a question about this study, I may contact Adam Everson by phone, at (469) 834-2233, or by e-mail, at If I have any questions about my rights as a research participant, I may contact the UCO Institutional Review Board by phone, at (405) 974-5479, or by e-mail, at

• For this study, I will complete a variety of questionnaires that will be presented online, which should take approximately 30 to 45 minutes. Upon completion of the survey, I will be able to enter my email address for the chance to win a $5 gift card.

• I may only complete the study one time. The drawing for the gift card is limited to one entry per individual.

• I understand that there is minimal risk associated with my participation in this study. That is, I understand that I will be answering questions about items that may be personal in nature. Some of these items may make some participants slightly uncomfortable. However, I also understand that participants in this study may gain insight into their own psychological state by answering the items in this survey. In addition, they will be exposed to the research process by participating in the studying, which is a benefit to the participants as well as the researchers in this study. I understand that I have the right to refuse to answer any question.

• This study is voluntary – I do not have to participate if I choose not to, and I may withdraw from the study at any time without penalty. I understand that I may refuse to answer any question at any time without penalty or loss of benefits, although I understand that completion of the study is necessary to be eligible for the gift card drawing.

• I understand that this study is anonymous – any information collected from me will only be used in an analysis as part of a larger group of participants. Any identifying information (i.e., my e-mail address) will only be used for the purpose of the gift card drawing. Moreover, the online data collection mechanism used in the study (i.e., will de-identify the answers provided by me, such that none of my responses will be linked to me. To this end, I understand that the researchers cannot refer me to anyone on the basis of my answers to the materials, but if I would like to visit with someone regarding sensitive or special concerns, I may contact the UCO Student Counseling Center by phone, at (405) 974-2215, or by visiting their website, at

• I understand that I must be 18 years of age or older to participate.

I understand that, by agreeing to participate in this research, I do not waive any of my legal rights. I understand that the research investigator named above will answer any of my questions about the research procedure and my rights as a participant. I understand that the research investigator is also available and willing to answer any questions I may have about the nature, importance, or contribution of the results of this study. I understand all of the above information and understand that I will not be deceived during the course of the study. I hereby agree to participate in the above-described research. I understand my participation is voluntary and that I may withdraw at any time without penalty. By continuing, I affirm that I am at least 18 years of age. I have read and fully understand the above consent form. By continuing, I provide my consent to participate in research.