Consent Form

You are being asked to take part in a photo contest focusing on the wellbeing of the community.
You are being asked to participate because you live in a community. Please read this form
carefully and ask any questions you may have before agreeing to take part in the study. Any and
all questions about this consent form can be directed by texting or calling (860) 208 - 7358, or
emailing mbonf1@unh.newhaven.edu.
The purpose is to learn how social media has an effect on users within a community. To study
how social media affects community wellness we need users of social media, specifically
Instagram. Instagram is a newer form of social media, so its effects are not well known.
If you agree to be a part of this study you will be asked to fill out a demographic survey to gather
knowledge of our community. Following, we ask you submit a photo. These photos will be used
in a contest. The photos will be viewed and liked by people in the community. All photos will
remain anonymous with the only identifier being a participation number, only the researchers,
Madelynn, Zachary, and Maria will know which photo belongs to which participant.
You waive the right to anonymity if you chose to send any self-identifying photos; i.e, photos of
yourself. You will receive an email with the number of likes you received on your photo along
with a second short survey.
There is a small risk that your feelings may be influenced by the number of likes you received.
This risk is no more than what you would encounter if you uploaded a photo on your own
personal Instagram page.

There are a few direct benefits for participation, first this entire study can be done from a
computer or a mobile phone. It takes only 20 minutes of your time over a course of 4 days to be
eligible to win a $30 VISA card. Participation is minimal: two surveys and submitting a photo.
All information will be kept confidential by using numbers as identifiers. Files will be kept on a
password protected flash drive and used on a computer that is wiped of all data at the end of the
day. Only the researchers: Madelynn Bonfiglio, Zachary Pelletier, Maria Vlahos, and Dr.
Guzmn will have access to the flashdrive and all files. Once all data are collected and analyzed,
the email used for communication will be deactivated and all individual emails are deleted. The
survey responses are completely anonymous, the responses will be deleted and the account
associated with the surveys will be deactivated. The flash drive will be wiped of all files and
smashed upon analysis of data.
This entire study is voluntary. If at any point you feel you no longer want to participate you have
the option to stop with no repercussions. We will delete any and all emails, files, survey
responses or photos you have sent in. You may skip any questions that you do not want to
answer.
If you have any questions, comments, or concerns regarding this study, please contact the
researchers Madelynn Bonfiglio at (860)-208-7358, Zachary Pelletier at (860) 970-2223 or Maria
Vlahos at (917) 837-1858.
If you have any questions or concerns regarding this study or your rights as a research
participants and would like to talk to someone other than the researcher(s), contact the chair of
the Institutional Review Board at UNH, Alexandria Guzmn at (203) 479-4562.

I have read the above information, and received answers to any questions I asked.
I am over 18 and I consent to take part in the study.
Type Here: __________________________ Date_______________________
In addition to agreeing to participate I also allow you to use my photos.
Type Here: __________________________ Date_______________________

Researchers Signature: ____________________________ Date: _________________

Researchers Signature: ____________________________ Date: _________________
Researchers Signature: ____________________________ Date: _________________