Personal/Intrapersonal Experience Report
Consent Form
We want to compare how different people feel about life. The Personal/Intrapersonal Experience Report (PIER) will ask you to indicate the degree to which 30 statements fit you personally. You will respond to each statement by clicking a circle on an adapted visual analogue scale which ranges from strongly disagree to strongly agree. The statements concern self-esteem, optimism, assertiveness, life satisfaction, interactions, and emotions. This should take less than five minutes to complete.
By helping us, you can enter drawings for several different prizes:
- a $50 Amazon gift certificate
- a $50 comic book order
- a FREE PASS to next year's Comic-Con International convention in San Diego, California
- a FREE PASS to next year's WonderCon convention in San Francisco
- a FREE PASS to this year's WizardWorld-Texas convention
- other books and comics which publishers have donated to support our work
1. Complete this consent form and the PIER survey yourself once.
2. If you get a friend to fill it out, you'll get an extra drawing entry. This should be someone who would not want the prize him/herself.
(Although, you're welcome to refer friends who would also like the chance to win prizes too.)
Even though you will enter your name on this consent form (which would be necessary to know if you won one of the convention passes), we will not store the consent form information and your survey information in the same file, so that your scores will be anonymous to us when we calculate them. You will need to enter the same e-mail address on both forms because if you complete the PIER survey randomly or fraudulently, we will have to discard that information and then discard your contest entry.
Your participation in the study should cause no risk or harm. If any questions cause you discomfort, please discontinue. Your participation is voluntary. Should you decide to stop at any time prior to completing the form, you may do so without any penalty, and you can request an opportunity to complete a non-psychological survey for the convention organizers as an alternative way to enter the drawing for the free convention pass.
When we complete the study, we will e-mail your scores to you if you indicate (on the bottom of the PIER form) that you want to know them. Likewise, our eventual findings can be made available to you as well. All responses will be kept confidential. If we publish our results, we will not include any identifying information about any participants.
We will be pleased to answer any questions you may have about our research.
Dr. Travis Langley
Department of Psychology
Henderson State University
E-mail: drtravislangley at yahoo
1. To show that you have read the above information about the study and give your voluntary consent to participate, enter your full name as your electronic signature:
2. Enter your complete mailing address IF you want to enter our prize drawings:
3. Enter your e-mail address. You will enter the same e-mail address on the PIER form so that we can be certain everyone who completes the PIER has first completed a consent form.
4. Only individuals age 18 or above can enter the drawing. Only individuals 18 or above can legally or ethically consent to participate in our study. Therefore, we must confirm age. This also helps us provide additional confirmation of identity in case you win the drawing.
Age (two-digit number, 18 or above):
5. If someone else asked you to take this survey, please enter the full name and e-mail address of the person who referred you to this survey (and thank them for us).
If you are completing our survey in order to enter a drawing, which one of you is entering the drawing?
you the person who referred you
If the person who referred you is entering the drawing instead of you, please indicate why you did not enter the drawing yourself:
AFTER YOU CLICK THE
SUBMIT CONSENT FORM BOX, YOU WILL BE TAKEN TO THE PIER FORM.