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The dissertation of Kelley, IHM, MS_________________ entitled ...

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Information and Consent Form<br />

Grief in Women Religious 87<br />

This research project examines different aspects <strong>of</strong> grief. <strong>The</strong>se surveys should take<br />

about one hour <strong>of</strong> your time at most, and all your responses are confidential. Your<br />

responses will not be shown or given to anyone else, only the person who is given these<br />

surveys to you will see them and your name will not be on them. Overall results will be<br />

reported as group data, rather than individually.<br />

Your participation is completely voluntary, and if you feel uncomfortable you may<br />

discontinue at any time for any reason.<br />

If you are interested in hearing about the results <strong>of</strong> the study, write your name and phone<br />

number on a separate piece <strong>of</strong> paper (NOT on the survey) and the researcher will get in<br />

touch with you when the study is completed. This is the beginning <strong>of</strong> a study that will<br />

continue for several years, so there may be some delay in responding until all results are<br />

completed. If you have any questions feel free to contact Donna <strong>Kelley</strong>, <strong>IHM</strong> at<br />

dmkelley@loyola.edu or 410-337-1462 or David Powers, Ph.D. at dpowers@loyola.edu<br />

or 410-617-2093.<br />

Thank you very much for your consideration. If you are interested in participating,<br />

please sign the following statement<br />

I have read the information provided and agree to participate in the survey. I<br />

understand that my participation is voluntary and that I may stop participating at<br />

anytime.<br />

________________________________________<br />

Participant Date<br />

________________________________________<br />

Researcher Date

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