INTRODUCTION: The purposes of this form are to provide you (as a prospective research study participant) information that may affect your decision as to whether or not to participate in this research and to record the consent of those who agree to be involved in the study.

RESEARCH: Jacqueline Webster, MC, Graduate Student and Dr. Andrew Carpenter, Grand Canyon University have invited your participation in a research study.

STUDY PURPOSE: The purpose of the research is to evaluate the relationship between racial attitudes and cultural competency.
DESCRIPTION OF RESEARCH STUDY: You are eligible for this study if you are a behavioral health counselor, therapist, clinician, or social worker working in a behavioral health agency or private practice that provides direct therapy or counseling to clientele. If you decide to participate, then as a study participant you will participate in an online survey. You will be asked to complete a questionnaire. As a study participant, you can skip questions on the questionnaire if you decide to do so. At the completion of the questionnaire, you will be asked to provide the researcher’s contact information and study link to another behavioral health professional. If you say YES, then your participation will last for 30-45 minutes. You are not required to complete the questionnaire at any particular location, as the questionnaire is available online.  Approximately 120 participants will be participating in this study in the state of Arizona.

RISKS: There are no known risks from taking part in this study, but in any research, there is some possibility that you may be subject to risks that have not yet been identified.
BENEFITS: The possible benefits of your participation in the research is that you will have an opportunity to enter a drawing for an electronic tablet. Your participation in the drawing is voluntary. Although there may be no additional, direct benefits to you, your participation in this study will help generate information and awareness that will help counselors working in diverse settings. 

NEW INFORMATION: If the researchers find new information during the study that would reasonably change your decision about participating, then they will provide this information to you.

CONFIDENTIALITY: All information obtained in this study is strictly confidential. The results of this research study may be used in reports, presentations, and publications, but the researchers will not identify you. In order to maintain confidentiality of your records, you will not be asked to provide identifying information on the questionnaire. If you choose to enter the drawing for an electronic tablet, you can provide an email address to the researcher and your email address will be stored electronically in a password protected file. All email addresses and data obtained from the questionnaires will be deleted at the completion of the research. 

WITHDRAWAL PRIVILEGE: Participation in this study is completely voluntary. It is okay for you to say no. Even if you say yes now, you are free to say no later, and withdraw from the study at any time. Due to the anonymity of the questionnaire, your withdrawal or nonparticipation will not affect your employment status. 

COSTS AND PAYMENTS: The researchers want your decision about participating in the study to be absolutely voluntary. Yet they recognize that your participation may pose some inconvenience due to time. There is no direct payment for your participation in the study. However, you will have an opportunity to enter a drawing for an electronic tablet if you choose to do so enter the drawing.

continued on next page...