Consent Form
Research Title - Examining the effects of social media on body dissatisfaction

Date of the Study - November 2014 to May 2015

Information about me and the research study - My name is Matthew Baike-Ghazvini and I am a student at Teesside University, currently studying Sport and Exercise Science (Applied Sport Science). The research I am conducting is in relation to the effect of social media on several psychological factors relating to body image. There are 5 different questionnaires which have a total of 75 questions; it should not take you longer than 20 minutes to complete the questionnaires.

Consent Information

1. I confirm that:
   • I am willing to take part in the above research project as a volunteer participant.
   • I don't have a history of mental illness.
   • I am currently an undergraduate student, studying in the UK.

2. I understand that:
   • I am free to withdraw from the study at any time without the need to give reason
   • I have/will inform the researcher in charge of any permanent and/or temporary mental health conditions from which I am suffering or have suffered recently
   • I agree that my data may be stored and used for the purpose of publication of the study
   • I understand that in accordance with the 1998 Data Protection Act my data will be anonymous and stored securely
   • I will not be receiving any feedback from the questionnaire and the results are solely for the collection of data in this
research study
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The purpose of this passcode is to allow you to participate anonymously. If you wish to drop out of this research study, please e-mail me your chosen passcode and your data will be deleted.
Do you give Matthew Baike-Ghazvini consent to use your information as data for the above research study? *
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