Department of Psychology

 Informed Consent Form


Title of Study: Social Inequalities Survey

Description of Experiment: Participants will be asked to complete a survey about social inequalities in the U.S. In order to participate in this research study, it is necessary that you give your informed consent. By completing this informed consent statement you are indicating that you understand the nature of the research study and your role in that research and that you agree to participate in the research.

Please consider the following points before signing:

  • I understand that I am participating in psychological research;
  • I understand that my identity will NOT be linked with my data, and that all information I provide will remain confidential. The name I provide after the study is over will only be linked to a separate LOC-R database (for Muhlenberg students), so I receive proper credit for my participation;
  • The study has IRB approval from the Psychology Department at Muhlenberg College.
  • Potential risks of participating include experiencing minimal psychological harm in the form of guilt or depressive thoughts when thinking about issues of disparity. The study may also conjure up memories of felt, enacted, or courtesy stigma in some participants, which could cause them stress.
  • Potential benefits of participating include an increased knowledge base regarding issues of social inequality in the U.S. and the option to be entered into a raffle to receive a $100 Target Gift Card upon survey completion.
  • I understand that participation in research is not required, is voluntary, and that, after any individual research project has begun, I may refuse to participate further without penalty.
  • I understand that certain facts about the study might be withheld from me, and the researchers might not, initially, tell me the true or full purpose of the study. However, the complete facts and true purpose of the study will be revealed to me at the completion of the study session.
  • I understand that I will be provided with an explanation of the research in which I participated and be given the name and telephone number of an individual to contact if I have questions about the research. In addition, I understand that I may contact the Psychology Department Coordinator of Human Participants Research, Alan Tjeltveit, at 484-664-3420, if I have questions concerning my rights as a participant in psychological research or to report a research-related injury.

REGARDING LOC CREDIT (MUHLENBERG STUDENTS ONLY): Muhlenberg College students who have signed up on the LOC board will be eligible for LOC credit. This is limited to the first 80 students who sign up. Participants accessing this study from a link other than the one provided through email from the experimenter will NOT receive course credit for their participation. In addition to completing the LOC questionnaire at the end of the survey, your name MUST appear on the LOC sign up sheets outside of the psychology office in order to receive credit for your participation!

If you have any further questions about the study feel free to contact us at the email addresses listed below:

Julie Klein

Stefanie Sinno, Ph.D. (advisor)


Please indicate your choice below. If you wish to participate in the study click on "consent". If you choose not to participate in the study at this time click on "decline".


Consent. Clicking on "consent" indicates that you are over 18 years of age, that you understand the above information, and that you consent to participate in this study being conducted at Muhlenberg College.



Decline Clicking on "decline" indicates that you choose not to participate in the study at this time.