4/28/2014

A Study on impressions of Psychological Services Survey

A Study on impressions of Psychological Services

Debriefing Form (PRINT THIS FORM FOR YOUR RECORDS)
Debriefing Form
To receive credit for your course, print this form and present it to your instructor.
Thank you for participating in my study. The survey you completed measured personality, coping
strategies, and help-seeking attitudes. This project was conducted by Marcus Cherry, B.A. under
the direction of Dr. Margret Cochran as a part of the requirements for the completion of the
Clinical Psychology graduate program at Northwestern State University.
To the best of my knowledge, this investigational procedure did not pose any more risk of harm
than you would experience in everyday life. Having participated in this study, you may have an
increased self-awareness and the satisfaction that comes with research and discovery. We
appreciate your assistance in our research effort and hope you found the experience rewarding.
We do not promise, however, that you will receive any of these benefits.
To participate, you had to be at least 18 years old at the time of survey. By filling out the first
question you indicated your willingness to participate in this study. Please be aware that:
1. Your participation in this survey was voluntary and you could have discontinued at any time
without penalty.
2. For students, participation or non-participation will not affect your grade.
3. Only the primary investigator and thesis advisor will have access to your results.
4. The survey contained a series of questionnaires that took 35 to 45 minutes to complete.
5. Most of the questions provided a statement such as I like sports followed by a ranking system
of Disagree strongly to Agree strongly. Other questions were multiple choice or fill in the blank.
6. Aside from this mild time investment, there were no costs associated with taking part in this
study.
7. Neither the person in charge of the study nor any personnel involved in this study had any
financial or personal interest in any company or instrument being used.
8. This study was anonymous. That means that no one, not even members of the research team,
will know that the information you give came from you.
You may receive research participation credit for participating in this study. Equivalent alternative
assignments will be available for those who elected not to participate. Your instructor will
determine the number of points to be distributed.
Your information will be combined with information from other people taking part in the study.
When we write up the study to share it with other researchers, we will write about this combined
information. You will not be identified in these written materials.
By completing this survey, you have given us permission to use your recorded data. The results of
this study may be published in a journal article or it may be presented at a professional
conference, but no publication or presentation will contain information that will identify you.
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4/28/2014

A Study on impressions of Psychological Services Survey

If you have any questions or concerns you may contact Marcus Cherry or Dr. Margret Cochran, my
thesis advisor in the psychology department at 318-257-6594. Overall, there is a small chance that
some of the questions may have caused you some discomfort. If you experienced any significant
stress because of your participating in this study, free counseling services are available at to
students at the NSU Counseling Center (318-357-5612) located in room 305 of the Freidman
Student Union.
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