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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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questionnaires, and your child‘s name will not be written on the questionnaires <strong>or</strong> audio<br />

tapes. Instead, a code will be written on the survey and other data. Only the researcher<br />

will be able to link your data to your identity with an identification key. All data will be<br />

st<strong>or</strong>ed in a locked and secured location, and only the researcher will have access to them.<br />

When all coding <strong>of</strong> audio tape content is done, all tapes will be destroyed.<br />

PARTICIPATION<br />

Your participation and your child‘s participation are voluntary, and you may choose to<br />

leave the study at any time and f<strong>or</strong> any reason. If you decide not to participate <strong>or</strong> leave<br />

the study, you will not lose anything. There are no costs to you <strong>or</strong> your child.<br />

CONTACT<br />

This project is being done by Melissa Mincic, M.A., <strong>of</strong> the Psychology Department at<br />

Ge<strong>or</strong>ge Mason University. You can contact her at (703) 772-3169 f<strong>or</strong> questions <strong>or</strong> to<br />

rep<strong>or</strong>t a problem with the study. You may also contact Dr. Susanne Denham, Ms.<br />

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

(703) 798-5574 (home) f<strong>or</strong> questions <strong>or</strong> to rep<strong>or</strong>t a problem with the study. You may<br />

contact the Ge<strong>or</strong>ge Mason University Office <strong>of</strong> Research Subject Protections at 703-993-<br />

4121 if you have questions <strong>or</strong> comments about your rights <strong>or</strong> your child‘s rights in the<br />

study.<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 />

184

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