| Introduction
Thank you for signing on to the survey. My name is Robert T. Carter,Ph.D. I am a Professor of Psychology and Education at Teachers College, Columbia University. I am a Black male psychologist. I have published books and journal articles on race and racial identity. I am interested in enhancing people's understanding of how Blacks and other People of Color experience discrimination and its effects on them over time. In order to accomplish this, I am asking participants to fill out a brief survey on discriminatory experiences they have had because of their race. I understand that reporting or describing experiences of racial discrimination can be difficult and even painful. However, without your story it will be hard to document the effects of discrimination.
You will also be asked to list some personal data (e.g. race, gender, age etc.), but you will not be asked to provide your name or any other identifying information. Your responses will be completely anonymous. Additionally, please do not use names or other descriptive information that could lead to the identification of others. In order to assure that nobody sees your responses on the computer you are using, please exit your web browser when you are done with the survey.
Consent Form
Submitting my answers to this survey indicates that I am informed about this study and willing to be a participant.
I understand that my participation in this study involves filling out a brief questionnaire on this web site. My participation is voluntary and I may stop filling out the survey at any time. I am also aware that my answers to the survey questions will be collected for research purposes. All responses are anonymous and will remain within the confines of the research group. I understand that the findings based on all of the participants’ surveys will be reported in summary form. By continuing and submitting my responses, I give my consent to have my responses used in this way.
This study has been approved by Teachers College, Columbia University Institutional Review Board. Protocol # 03-016.
If you would like to print this information for your records, please click on the print button on your web browser.
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