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Researchers: Sylvia Burgio, York University, 647-989-2358

Purpose of the Research: The purpose of this research is to gain a greater understanding of someone’s willingness to sacrifice in a relationship depending on low and high self-efficacy and Long Distance Romantic Relationships and Proximal Romantic Relationships.



What You Will Be Asked to Do in the Research: You will be asked to complete a Demographic Questionnaire followed by 2 other measures.



Risks and Discomforts: We do not foresee any risks or discomfort from your participation in the research.



Benefits of the Research and Benefits to You: Your Participation will help in advancing research on Long Distance Relationships that is on the rise.



Voluntary Participation: Your participation in the study is completely voluntary and you may choose to stop participating at any time. Your decision not to volunteer will not influence the nature of the ongoing relationship you may have with the researchers or study staff nature of your relationship with York University either now, or in the future.



Withdrawal from the Study: You can stop participating in the study at any time, for any reason, if you so decide. If you decide to stop participating, you will still be eligible to receive the promised remuneration, if any, for agreeing to be in the project. Your decision to stop participating, or to refuse to answer particular questions, will not affect your relationship with the researchers, York University, or any other group associated with this project. In the event you withdraw from the study, all associated data collected will be immediately destroyed wherever possible.



Confidentiality: All information you supply during the research will be held in confidence and your name will not appear in any report or publication of the research. The data will be collected through handwritten notes. Do not put your name on any of the documents that we provide to you- with the exception of this Informed Consent Form (ICF). This form will be kept separate from any other material that you are given so that we will never be able to identify who completed what tests etc. Your data will be safely stored in a locked folder and only research staff will have access to this information. If this study includes observational data collection- the researchers will never disclose the name of the participant associated with any such obtained data. This data will be stored for 2 years after the Study and will then be destroyed. Confidentiality will be provided to the fullest extent possible by law.



Questions About the Research? If you have questions about the research in general or about your role in the study, please feel free to contact Dr. Ed Haltrecht either by telephone at (416) 736-2100, extension 66178 or by e-mail (haltrech@yorku.ca) This research has been reviewed and approved by the Human Participants Review Sub-Committee, York University’s Ethics Review Board and conforms to the standards of the Canadian Tri-Council Research Ethics guidelines. If you have any questions about this process, or about your rights as a participant in the study, please contact the Sr. Manager & Policy Advisor for the Office of Research Ethics, 5th Floor, York Research Tower, York University (telephone 416-736-5914 or e-mail ore@yorku.ca).



I consent to participate in this study. I have understood the nature of this project and wish to participate. I am not waiving any of my legal rights by consenting to this form. My agreement below indicates my consent.



