Principal
Mr. Peter J. Mannarino
Assistant Principals
Mrs. Rosemary DeGennaro
Mrs. Evelyn P. Russo
AR Director
Ms. Stephanie A. Strauss
Christ The King Regional High School
Advanced Research Program
Accredited by:
The Board of Regents of the State of New York
The Middle States Association of Colleges and Secondary Schools
CONSENT FORM FOR ADULTS
Project Title: Stress and its affect on Lucid dreaming.
INVITATION TO PARTICIPATE IN A RESEARCH PROJECT:
You have been invited to participate in a student research project designed to test the lucidity of an
individual, and how it is affected by the individual's stress level. The student researcher conducting
this survey is participating in the INTEL, NYCSEF and the Quality of Life Program and
Scholarship Competition, applied research competitions for high school students. The student
researcher is being supervised by a high school teacher.
Description of Survey
The survey consists of 28 questions and will take approximately 5 minutes to complete. The
questions cover topics related to stress and lucid dreaming.
Risks & Benefits
There are no risks to participating in this research project because the subjects will not, in any way,
feel uncomfortable answering any of the questions included in the survey.
The benefit from participation is that the results of research will be used to develop a proposal to
improve the quality of life, and it may even help the student researcher earn a scholarship for
college of up to S 17,500. If selected to become a semifinalist, the student researcher will also have
an opportunity to personally present the results of the study to city officials. foundation executives
and university researchers. This project may be nominated for $1,000 in seed money to support the
implementation of the proposal.
If you choose to participate, your responses will be kept confidential. You may choose not to
participate, or to withdraw from participation at any time, or not to respond to individual questions
on the survey.
For more information or if you have any questions, you may contact my teacher supervisor,
Stephanie Strauss, Christ the King H.S. at sstraussrdzctkrhs.orz for additional information.
You are making a decision about whether or not to participate in a high school student's research
project. Your signature below indicates that you have been made aware of the projects description
and purpose, any potential risks and benefits, and of the researcher's obligation to ensure
confidentiality.
Your signature indicates that you have read the information provided above and have decided to
participate. You may withdraw at any time without prejudice after signing this form should you
discontinue participation in this study.
Print Name:
Signature: _
Date: _
68-02 Metropolitan Avenue, Middle Village, New York 11379
718-366-7400 Fax: 718-366-1165
www.ctkrhs.org
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