IRB Consent Form – English


Dear Parent/Guardian(s),

You are invited to join in the Paterson Coalition Against Substance Abuse (P-CASA) PRIDE survey. The survey gathers information on parents’ attitudes and beliefs about their children. This information can help identify what places youth at risk for substance abuse. You were selected because you hold important information about youth in this city. Survey questions focus on child’s school life, family interactions, safety, grades, and alcohol, tobacco, and other drugs.

This survey can be finished in about 30 minutes. You may not directly benefit from this research, but this study will help P-CASA’s future prevention activities. Other prevention programs in Paterson, NJ, may benefit from this study. You may become upset or aware of negative aspects of your child’s daily life. You may feel uncomfortable sharing personal information.

Data will be collected using the Internet. Security of data sent over the internet cannot be guaranteed. Privacy will be kept to the degree allowed by the technology used. We advise that you do not use an employer’s computer, laptop, or phone to respond to this survey.

If you decide to participate, you are free to stop at any time. You may skip questions you do not want to answer. Please feel free to ask questions regarding this study. You may contact me Dr. Robert Reid (Principal Investigator) by phone or email: 973-655-6785, or <a href=”mailto:[email protected]”>[email protected]</a>.

Any questions about your rights may be directed to Dr. Katrina Bulkley, Chair of the Institutional Review Board at Montclair State University at [email protected] or 973-655-5189.

Thank you for your time.
Dr. Robert J Reid
College of Education and Human Services
Department of Family and Child Studies
Montclair State University

Clicking the link below confirms that I have read this form and will take part in the project described. To my satisfaction, the surveys general purposes, details of involvement, and possible risks and inconveniences were explained. I understand that I can discontinue participation at any time. My consent also confirms that I am 18 years of age.

The study has been approved by the Montclair State University Institutional Review Board as study #001464 on October 1, 2013.