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SUNY-Oneonta, Department of Psychology (revised 3/99) SUBJECT PARTICIPATION FORM PART 1. This section should be completed by the EXPERIMENTER

Name of Participant (print):

PSYC 100 Section: Participation Credits:

Name of Experimenter (print):

Experimenter's Signature:

Name of Experiment:

Number Code of Experiment

PART 2. This section should be completed by the PARTICIPANT

(A) Participant's Signature______________________________________________
(B) Please write a brief description of the task and your understanding of its purpose.

(C) Please answer the following questions using this scale:
SA = strongly agree; A = somewhat agree; D = somewhat disagree; SD = strongly disagree

The experimenter was courteous to me. _________
The experimenter was well organized and prepared. _______
The rationale of the experiment was explained to my satisfaction. _______
The experience of participating in this experiment was valuable. _______

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To the participant: Please return this form to your PSYC 100 teacher. He or she will keep the portion above the dotted line. You will keep this receipt (the portion below the dotted line); it verifies that you participated in the experiment described below.

Your name (print): PSYC 100 Section

Name of Experiment: Participation Credits:

Number Code of Experiment: Date of participation: