Appendix _. Young adult’s consent form (English). California State Polytechnic University, Pomona Informed Consent Form for Research Involving Human Subjects You are being invited to participate in a research study, which the Cal Poly Pomona Institutional Review Board (IRB) has reviewed and approved for conduct by the investigators named here. This form is designed to provide you – as a human subject – with information about this study. The Investigator or his/her representative will describe this study to you and answer any of your questions. You are entitled to an Experimental Research Subject’s Bill of Rights and a copy of this form. If you have any questions or complaints about the informed consent process of this research study or your rights as a subject, please contact the Compliance Office within Cal Poly Pomona’s Office of Research and Graduate Studies at (909) 869-4215. More information is available at the IRB website, www.csupomona.edu/research/irb. The Protocol number for IRB is 14-0034. A Cyber Bullying Prevention Website For Young Adults Between the Ages of Eighteen To Twenty-five. As a Vietnamese adult, you are being invited to take part in a study titled “Cyber Bullying Prevention for Adults”. Emily Vu is a graduate student at California State Polytechnic University, Pomona, who is conducting this study in order to fulfill the requirements for a Master of Arts in Education Degree with a Specialization in Educational Multimedia. If you choose to volunteer in this formative evaluation, you will be asked to visit the website at http://www.csupomona.edu/~atvu/ThesisProject/ to review a cyber bullying intervention website created by Ms. Vu. The purpose of this study is to evaluate the effectiveness of the website in educating young adults about cyber bullying and providing strategies to detect and address cyber bullying when it occurs. If you feel that on account of your prior relationship with the PI your participation in this study will create a conflict of interest or if the topic of bullying will cause you any amount discomfort, please disregard this email. In the event that this email has caused you any stress you may at your own discretion seek counseling from either a school counselor, who will provide confidential support. Sharing your experience with professionals will help reduce your discomfort. You will be one of the initial users of “Cyber Bullying Prevention Online Program”, a website that contains several interactive lessons designed to help young adults learn about safe strategies when faced with cyber bullying situations. You will be encouraged to explore the website and try several of the lessons. After you have spent some time interacting with the website, you will be asked to submit your opinions about the website through an anonymous survey available at https://docs.google.com/forms/d/1hrqwN7LRES8_boQg3wV5PsEsLK9mI4MFYXy8_eWPC0/edit. Participation in this study is not mandatory – it is completely voluntary. If you choose to participate, you may elect to stop participating in the study at any time, with no consequence. Choosing to participate will not improve your current leadership standing in the Vietnamese Eucharistic Youth Group in any way, while choosing not to participate will not harm you in any way. You will not be compensated for participating. Based on the research that is being done, there is a minimal risk to you. Any data collected will be compiled so that no responses can be linked to any participant. The researcher (Emily Vu) will be the only individual who will have access to any data collected during this study. To ensure the protection and security of any data collected, it will all be stored in the researcher’s password protected home computer. All data will be provided anonymously and kept anonymous. Furthermore, any data collected through this study will be destroyed after the study is complete. If you have any questions or concerns, you may contact the researcher by phone at (626) 217-7919, or by e-mail at [email protected] You may also contact the researcher’s graduate advisor at California State Polytechnic University, Pomona, Dr. Christina Dehler, by phone at (909) 869-4084 or by email at [email protected] If you would like to visit the website, you may do so by going to: http://www.csupomona.edu/~atvu/thesisproject/. Your feedback will inform the researcher of the modifications needed to improve the website and will be included in her master’s thesis. If you consent to participate in this review of the website, please type your name and today’s date in the spaces provided at the bottom of this consent form, save, and return it to the researcher at [email protected], via email attachment, from your email account. This will serve as your electronic signature and your consent to participate in this study. Printed Name of Principal Investigator: Emily Vu Printed Name of Graduate Advisor: Christina Dehler I hereby consent to participate in this voluntary study. I will return the consent form electronically through email to Emily Vu at [email protected] This is an anonymous survey and it cannot be traced back to me. _____________________________________________ __________________ Printed Name of Participant Date You may print out a copy of this consent form for your record. Thank you for your time and participation.