Title: Mental states including empathy and mindfulness: What are the relationships?.

Investigators: Kim Woynowskie We are asking you to participate in a research study. Please take your time to read the information below and feel free to ask any questions before signing this document.

Purpose: This is a study that examines relationships among thoughts and feelings as experienced in yourself and others.

Procedures: The study consists of four brief surveys and a few demographic questions. Some of the questions are similar to each other, but all of the questions are significant to the integrity of the study. The entire survey should take approximately 20 minutes. Your full participation is very much appreciated.

Risks to Participation: There are no known risks associated with the study.

Benefits to Participants: Participating in the study may increase insight about oneself since it involves answering questions about how one thinks and feels regarding others. Some people also feel a sense of satisfaction at having contributed to our understanding of the mind.

Alternatives to Participation: Your participation in this study is voluntary and you may stop at any time without consequence.

Confidentiality: Participation in this study is anonymous. Identifying information is not collected, and all responses will remain confidential. Your information will not be shared or sold to third parties.

Questions/Concerns: If you have any concerns, or feel your participation has resulted in any physical or emotional discomfort, or if you have any questions regarding participation in the study you may contact:

Primary Investigator: Kim Woynowskie, M.A., kmw3920@ego.thechicagoschool.edu

Dissertation Chair: Guy Balice, Ph.D, gbalice@thechicagoschool.edu

If you have questions concerning your rights in this research study you may contact the Institutional Review Board (IRB), which is concerned with the protection of subjects in research project. You may reach the IRB office Monday-Friday by calling 312.467.2343 or writing: Institutional Review Board, The Chicago School of Professional Psychology, 325 N. Wells, Chicago, Illinois, 60654

Consent: By clicking the button below I acknowledge that I have read the description of the research project and procedures, and that I am at least 18 years of age. I agree to participate in this study. My participation is voluntary and I understand I can quit at any time. I do not have to sign this form if I do not want to be part of this research project. I will receive a copy of this consent form for my records.