Work-Life Interference: Attempts for Balance

Informed Consent Document
Work-Life Interference: Attempts for Balance
Purpose
You are being asked to participate in a research study about Work life interference/Work Life Balance study. The purpose of this research is to measure how work-life interference interrupts work-life balance. You were selected as a possible participant because you are a student and you work. Please read this form and ask any questions that you may have before agreeing to be in the research.
Information about Participants’ Involvement in the Study
The study will take place in any convenient place for the participant. It should take you approximately 5-10 minutes to complete the research study.

If you agree to be a participant in this research, we would ask you to do the following things:
Take this survey and answer the items best to your understanding.

Risks
This research has the following risks:
No risks higher than a regular every day activity.
Benefits
The benefits of participation are to help enhancing the understanding of work-life interference regarding work-life balance issue.

Confidentiality
The information in this research will be kept confidential. Your answers will be recorded as a number (your answer to the scale). Research data will be stored in a secure location. The data will be kept in Christopher J Carpenter office in Memorial Hall 318. The data will be made available only to the persons conducting the research. No reference will be made in oral or written reports that could link participants to the research.

Voluntary Participation
You do not have to perform any activity you do not want to. You do not have to answer any question you do not want to answer. Participation in this study is voluntary. If you decide to participate, you may withdraw from the study at anytime without penalty and without loss of benefits to which you are otherwise entitled.

Contact Information:
If there are any questions at any time about the study or the procedures, or you experience adverse effects as a result of participating in this study, please contact:
Christopher J. Carpenter
Communication Department
WIU
(309) 298-1622
Cj-carpenter2@wiu.edu

This project has been reviewed and approved by the WIU Institutional Review Board. Questions concerning your rights as a participant in this research may be directed to IRB Administrator, at (309) 298-1191 or IRB@wiu.edu.
Consent:
I have read the above information, and I have received a copy of this form. I agree to participate in this study.

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    Part One:

    General Information
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    Part Two:

    Please circle the answer that fits your standpoint: (1 strongly Disagree, 7 being Strongly Agree)
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    Your information for the (Extra Credit)

    Remember you have to click "Submit" to earn the extra credit
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