I, _____________________________ (print your name) understand that I have been asked to participate in a class project for _________________________ (student's name). This project will help _________________________ (studen'ts name) meet the requirements for her/his Psychological Tests and Measurements class. In this project, I will be asked to complete a measure of motivation. I understand that my participation in this project will be kept in strictest confidence and that in the written report of the results my real name will not be used. I also understand that I may withdraw from the project at any time, with no consequences. My questions and concerns about my participation have been answered to my satisfaction. Additional questions about this study should be directed to Dr. Steven Wininger at 270-745-4421. Questions about rights as a research participant should be directed to the Human Protections Administrator, Dr. Phil Myers at 270-745-4652.

    _________________________ __________
    (signature of interviewee)              (Date)

    _________________________ __________
    (signature of student)                    (Date)