Consent Form

Question Title

* 1. CONSENT TO PARTICIPATE IN RESEARCH

Bereavement Group Research:


You are asked to participate in a research study conducted by Matt Streicher from the Department of Psychology and Sociology at Coastal Carolina University. This study is being conducted as part of an undergraduate thesis project. Your participation in this study is entirely voluntary. Please read the information below before deciding whether or not to participate.


* PURPOSE OF THE STUDY
The purpose of this study is to measure the emotional and behavioral changes the bereaved may experience throughout participation in support groups.

* PROCEDURES AND POTENTIAL BENEFITS TO SUBJECTS AND/OR TO SOCIETY
If you volunteer to participate in this study, you will be asked to complete the Hogan Grief Reaction Checklist. This study will benefit further research on the overall effectiveness of bereavement groups as well as benefit the future bereaved if they choose to participate in a bereavement program.

* POTENTIAL RISKS AND DISCOMFORTS
If participation results in discomforts or inconveniences, you may withdraw from the study. In the event of physical and/or mental injury resulting from participation in this research project, Coastal Carolina University does not provide any medical, hospitalization or other insurance for participants in this research study, nor will Coastal Carolina University provide any medical treatment or compensation for any injury sustained as a result of participation in this research study, except as required by law.

* CONFIDENTIALITY
Only aggregate data will be reported for this study. Any information that is obtained in connection with this study and that can be identified with you will remain confidential and will be disclosed only with your permission or as required by law.

* PARTICIPATION AND WITHDRAWAL
You can choose whether or not to be in this study. If you volunteer to be in this study, you may withdraw at any time without consequences of any kind or loss of benefits to which you are otherwise entitled.

If you have any questions or concerns about this research, please contact:

Matt Streicher
Candidate: B.A., Sociology
Phone: 301-787-8321
Email: mcstreic@g.coastal.edu

OR

Deborah Perkins, Ph.D.
Phone: 843-349-2693
Email: dperkins@coastal.edu


The Coastal Carolina University Institutional Review Board has reviewed my request to conduct this project. If you have any concerns about your rights in this study, please contact Bruxanne Hein, IRB Administrator at 843-349-2918 or email Bruxanne@coastal.edu.

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