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Agreement to Participate in Research



RESPONSIBLE INVESTIGATOR: Hisham S. Doumi

TITLE OF RESEARCH PROJECT: Self-concept and Academic Performance in Undergraduate Students



I have been asked to participate in a survey-based research study that is investigating the relationship, if any, between self-concept and academic performance. The results of this study should further our understanding of self-concept and self-esteem in relation to academic performance.



I understand that:

1. I will be asked to take a survey at home that should take approximately (5-10 minutes) to complete.

2. The possible psychological risks may involve some discomfort based on reaction to the survey questions. Should any feelings be elicited based on my or my child’s participation in this study, I may contact SF Department of Public Health’s 24-hour Behavioral Services helpline at 415-255-3737 or 888-246-3333. No physiological risks are anticipated.

3. There are no discernible benefits to me personally, although the results of this study will help expand our knowledge of self-concept and self-esteem as it pertains to academic performance.

4. Although alternative procedures may be used, the present procedure is the most advantageous and economical.

5. The results of this study may be published, but any information from this study that can be identified with me will remain confidential and the data will be pooled to maintain anonymity.

6. Any questions about my participation in this study will be answered by Hisham S. Doumi (Student Investigator) at HDoumiThesisProject@yahoo.com. Any questions or concerns about this study should be addressed to Dr. Nusha Askari (Principal Investigator, Professor, NDNU) at Naskari@ndnu.edu. Complaints or concerns about this study may be addressed to Dr. Kim Tolley, (Chair, Institutional Review Board, NDNU) at (650) 508-3464.

7. My consent is given voluntarily without being coerced. I may refuse to participate in this study or in any part of this study, and I may withdraw at any time, without prejudice to my relation with NDNU or with any future contact with NDNU.

8. I can print a copy of this consent form for my records.

note: If you would like to print a copy for your personal records, please follow your web browser's printing options (select File --> Print)



I HAVE MADE A DECISION WHETHER OR NOT TO PARTICIPATE. CHECKING YES INDICATES THAT I HAVE READ THE INFORMATION PROVIDED AND THAT I HAVE DECIDED TO PARTICIPATE.

