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Sample A: Cover Page of Thesis, Project, or Dissertation Proposal

Sample A: Cover Page of Thesis, Project, or Dissertation Proposal

Sample A: Cover Page of Thesis, Project, or Dissertation Proposal

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any reason. If you decide not to participate <strong>or</strong> if you withdraw from the study, there is no<br />

penalty <strong>or</strong> loss <strong>of</strong> benefits to which you are otherwise entitled. There are no costs<br />

affiliated you‘re your participation. Upon completion <strong>of</strong> the study, you will be paid $8.00<br />

per book reading session completed. Because Head Start will recess f<strong>or</strong> summer by the<br />

time the study is complete, payment will be mailed to you.<br />

CONTACT<br />

This research is being conducted by Melissa Mincic, M.A., <strong>of</strong> the Psychology<br />

Department at Ge<strong>or</strong>ge Mason University. She may be reached at (703) 772-3169 f<strong>or</strong><br />

questions <strong>or</strong> to rep<strong>or</strong>t a research-related problem. You may also contact Dr. Susanne<br />

Denham, Ms. Mincic‘s academic advis<strong>or</strong> at Ge<strong>or</strong>ge Mason University, at (703) 993-1378<br />

(w<strong>or</strong>k) <strong>or</strong> (703) 798-5574 (home) f<strong>or</strong> questions <strong>or</strong> to rep<strong>or</strong>t a research-related problem.<br />

You may contact the Ge<strong>or</strong>ge Mason University Office <strong>of</strong> Research Subject Protections at<br />

703-993-4121 if you have questions <strong>or</strong> comments regarding your rights as a participant in<br />

the research.<br />

This project has been reviewed acc<strong>or</strong>ding to Ge<strong>or</strong>ge Mason University procedures<br />

governing your participation in this research.<br />

CONSENT<br />

I have read this f<strong>or</strong>m and agree to participate in this study<br />

______________________________ ______________________________<br />

Name Date <strong>of</strong> Signature<br />

__________ I agree to be audio taped.<br />

__________ I do not agree to be audio taped.<br />

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