INFORMED CONSENT FORM
I understand that this study involves research conducted by Jason von Stietz, M.A., a student of the clinical psychology Ph.D. program at California School of Professional Psychology at Alliant International University, Los Angeles. I understand that this project is designed to examine mental toughness among strength athletes.
I have been asked to participate in this study because I meet three requirements. 1) I am fluent in English 2) I am over the age of 18. 3) I have competed in at least one sanctioned strength-sport competition (e.g., weightlifting, powerlifting, crossfit, or highland games) within the previous year. I understand that my participation in this study will involve the completion of a survey. The purpose of the survey is to measure beliefs about athletic ability, beliefs about success in sports, and obstacles to successful performance. Basic demographic information will also be measured. I am aware that my involvement in this study will take about 15 to 20 minutes of my time.
My participation in this study is voluntary. I may refuse to participate or withdraw from this study at any time without any consequences. If I feel discomfort during my involvement in this study I am encouraged to withdraw from the study and contact the primary investigator, Jason von Stietz, jvonstietz@alliant.edu. I understand that this study has been approved by Alliant International University Institutional Review Board and if I have any question about my rights as a research participant I am encouraged to contact the Institutional Review Board, Alliant-irb@alliant.edu. I understand that if I request to withdraw my responses after my participation in the study has been completed, it may not be possible to remove my data from the electronic records. I understand that information linking me to my responses has been eliminated in order to protect my anonymity. I understand that my identity as a participant in this study will be kept in strict confidence. No information that identifies me in any way will be released without my separate written approval. I am aware that all information that identifies me will be protected to the limits allowed by law. I have been informed that Jason von Stietz will keep all individual data collected about me, for the purposes of this study, confidentially in a password-protected database.
The answering of some questions on the questionnaires may make me feel uncomfortable. If this occurs, I may contact the principal investigator, Jason von Stietz, M.A., jvonstietz@alliant.edu, 949-836-6041. If I would like psychological assistance, he will find assistance in my area within 24 hours and will offer referrals. Psychological assistance will be provided to me at my own expense if I request it. If I experience an emergency due to or during the study, I will call 911 or go to the nearest emergency room at my own expense. I understand that a mental health referral list will be provided, at the beginning and end of the survey, which includes the L.A. County Mental Health Services at (800) 854-7771 and the American Psychological Association (APA) hotline at (800) 273-8255.
I am aware that I will not directly benefit from this study. My participation might lead to a better understanding of mental toughness. In turn, this might indirectly benefit the strength-sport community and society as a whole.
If I have any questions about this project or my participation in this study I may contact Jason von Stietz, M.A., jvonstietz@alliant.edu, 949-836-6041. I may also contact his supervisor James Garbanati, Ph.D., jgarbanati@alliant.edu, 1000 S. Fremont Ave., Unit 5, Building A8, Alhambra, CA 91803, (626) 270-3305. I understand that at the end of the study I may request a summary of results or additional information about the study from Jason von Stietz.
A request to be entered into a drawing to win one of three $20 gift cards can be made by emailing Jason von Stietz at jvonstietz@alliant.edu with the subject “$20 gift card.”
A request for the summary of the results of this study can be made by emailing Jason von Stietz at jvonstietz@alliant.edu with the subject “Summary of results.”
I understand that I am encouraged to print a copy of this agreement and keep it for my own records.
I have read this form and understand what it says. I am 18 years or older, I have competed in a sanctioned strength-sport competition, and I voluntarily agree to participate in this research project.