Author and Psychologist
Informed Consent Statement for Closed Bereavement Study

Informed Consent Statement for Closed Bereavement Study

This is a copy of an informed consent statement that SurveyMonkey Audience participants
read when considering to be a part of a bereavement study I am conducting. As promised, a copy of that
statement is below. Unfortunately, the study is closed to other participants at this time. If
interested in the topic click on this link to review preliminary results of the

Brief Summary of the Study

This study explores the ways people may or may not maintain a sense of connection to an
important other in your life who has died. This connection or bond may be something you
experience or foster in a variety of ways, such as visiting their grave or having a dream about them.
This study is being conducted by Mark Carlson-Ghost, Ph.D., Associate Professor of Clinical
Psychology at the Minnesota School of Professional Psychology (MSPP) at Argosy University. I am
interested in developing a better understanding of the various ways that people experience those
To agree to participate in this study you must first read a letter of informed consent. This informed
consent statement is required for academic research and covers information to consider before
deciding to participate. Thanks for taking the time to read it.

Letter of Informed Consent

As part of a pool of individuals offered to take online surveys, I must be 18 years of age or older to
participate in this study. I understand that participation is entirely voluntary and at a time of my
choosing. The researcher does not impose any consequences if I decide not to participate,
withdraw at any point, or decline to answer any question for any reason. Taking the survey will take
approximately 10-15 minutes. There are 33 multiple-choice questions in all. It is expected that
approximately 240 people will participate in this study.
If I agree to be in this study, I’ll select one important person in my life who has died. I will then be
asked multiple choice questions about that person, how we are related, whether I’ve experienced
various types of bonds to that person in the past year and how I felt about those experiences. The
survey also includes a few questions about my religious beliefs, if any, and my sense of my own
The risks associated with this study are minimal. There is a remote chance that taking this survey
will bring back painful memories of the person who passed away. If the death in question feels too
recent or I have concerns that taking the survey may distress me, I am encouraged not to take the
survey. I always have the option of not answering any question that I feel might cause me distress
or to stop taking the survey completely. If I do have distressing feelings that persist, I can contact
Mark Carlson-Ghost or visit and click on “Resources” to obtain information about
grief specialists in my area.
A possible benefit of participation in this study is that I may get ideas on positive ways to maintain
continuing bonds with a person who has passed away. I may also experience a sense of comfort in
knowing that I am not alone in some of the ways I maintain continuing bonds. I will not receive
compensation from the researcher or the university for my participation in this study.
The information I provide will be anonymous. The researcher will be unable to tie the information
I’ve provided to my name. The administrators of SurveyMonkey Audience will only have access to
information specified under the SurveyMonkey Audience Terms of Service agreement I have signed.
The survey data will be stored securely on an encrypted and password protected USB drive and
kept in a locked, secure location. Only the researcher or graduate students at the Minnesota School
of Professional Psychology working under the supervision of an MSPP faculty member will have
access to the records. The data will be destroyed five years after the last use of the data for
doctoral research or publication.
I am encouraged to make a copy of this informed consent page. I also have the right to get a
summary of the results of this study. A summary of prelimary results will be posted on the primary
researcher’s website, A copy of the informed consent is also available
I can contact the researcher if I have questions or concerns about this survey: Mark Carlson-Ghost,
Ph.D., Associate Professor of Clinical Psychology at the Minnesota School of Professional
Psychology at Argosy University, 1515 Central Parkway, Eagan, MN 55121. He can be reached at or 651-286-7970.
I understand that this study has been reviewed and certified by the Argosy Institutional Review
Board. For problems or questions regarding participants’ rights, I can contact the Institutional
Review Board Chair, Jeffrey Brown at 651-846-3524 or
1. Having read and understood the informed consent, are you willing to participate in this study?
Yes, I am giving my voluntary consent to participate and wish to continue
No, I have decided to not to take this survey


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