INFORMED CONSENT FORM

Please read the following information and give your consent to be part of the study.
The Researcher
 I Anandita Nair (B.A Psychology, English, Journalism) request you to participate in the
research study that I am conducting.
The Study
The purpose of this study is to gain insight into your likes, dislikes, attitudes, interests and
how you feel about certain situations. There is no right or wrong answer because everyone
has a right to their own views. All you have to do is answer what is true for you.
The Process
Your participation in the study will involve the filling of 5 questionnaires, which do not have
a time limit. It will take approximately 15-20mins for you to complete these questionnaires.
The responses in the questionnaire will be used to analyze the results. Please note that
findings from this study may be published and used in journals or article collections.
Risk
This study poses little to no risk to its participants. Confidentiality is maintained by not citing
your actual name within the actual study. Your participation in the study is voluntary and
you may choose to leave the study at any time. You may also request that any data
collection from you not be used in the study.
Your participation will help the research since your views are important.
By signing below, you agree that you have read and understood the above information and
would be interested in participating in this study.

Name                                          Date                                             Signature

                                                                                                                                                  
**thank you for agreeing to participate in this study.**
 DEMOGRAPHIC DETAILS

1) NAME - ....................................

2) AGE - .............

3) LEVEL OF EDUCATION - ......................

4) GENDER - .....................

5) SEXUAL ORIENTATION- .....................

6) EMPLOYMENT STATUS - .......................

7) BIRTH ORDER- ……………….

8) ECONOMIC STATUS- …………………

9) RELATIONSHIP STATUS………….

10) DURATION OF RELATIONSHIP

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Open with Photo Editor
 RAQ
 
RELATIONSHIP SURVEY INSTRUCTIONS: The items listed below refer to
people in a close  relationship--i.e., a relationship between two partners in an
intimate relationship. Please read each  item carefully and decide to what extent it is
characteristics of your feelings and behaviors. Give each  item a rating of how much
it applies to you by using the following scale: 
A = Not at all characteristic of me. 
B = Slightly characteristic of me. 
C = Somewhat characteristic of me. 
D = Moderately characteristic of me. 
E = Very characteristic of me. 

NOTE:  Remember to respond to all items, even if you are not completely
sure. Also, please be honest in responding to these items. 
1. I am a good partner for an intimate relationship. 
2. I am depressed about the relationship aspects of my life. 
3. I think about intimate relationships all the time. 
4. I am better at intimate relationships than most other people. 
5. I feel good about myself as an intimate partner. 
6. I think about close relationships more than anything else. 
7. I sometimes have doubts about my relationship competence. 
8. I am disappointed about the quality of my close relationship. 
9. I don't daydream very much about intimate relationships. 
10. I am not very sure of myself in close relationships. 
11. I cannot seem to be happy in intimate relationships. 
12. I tend to be preoccupied with close relationships. 
13. I think of myself as an excellent intimate partner. 
14. I am less than happy with my ability to sustain an intimate relationship. 
15. I'm constantly thinking about being in an intimate relationship. 
16. I would rate myself as a "poor" partner for a close relationship. 
17. I feel down about myself as an intimate partner. 
18. I think about intimate relationships a great deal of the time. 
19. I am confident about myself as a relationship partner. 
20. I feel unhappy about my interpersonal relationships. 
21. I seldom think about being involved in a close relationship. 
22. I am not very confident about my potential as an intimate partner. 
23. I feel pleased with my love relationships. 
24. I hardly ever fantasize about highly intimate relationships. 
25. I sometimes doubt my ability to maintain a close relationship. 
26. I feel sad when I think about my intimate experiences. 
27. I probably think about love relationships less often than most people. 
28. I have few doubts about my capacity to relate to an intimate partner. 
29. I am not discouraged about myself as a loving partner. 
30. I don't think about intimate relationships very often. 
31. I responded to the above based on: 
(A) A current intimate relationship. 
(B) A past intimate relationship. 
(C) An imagined intimate relationship. 
 Parental Authority Questionnaire 

Instructions: For each of the following statements, circle the number of the 5-point scale (1
= strongly disagree, 5 = strongly agree) that best describes how that statement applies to
you and your mother. Try to read and think about each statement as it applies to you and
your mother during your years of growing up at home. There are no right or wrong
answers, so don’t spend a lot of time on any one item. We are looking for your overall
impression regarding each statement. Be sure not to omit any items. 

1 = Strongly disagree 
2 = Disagree 
3 = Neither agree nor disagree 
4 = Agree 
5 = Strongly Agree
1.  While I was growing up my mother felt that in a well-run home the 12345
children should have their way in the family as often as the parents do.

2.  Even if her children didn’t agree with her, my mother felt that it was 12345
for our own good if we were forced to conform to what she thought
was right.

3.  Whenever my mother told me to do something as I was growing up, 12345

she expected me to do it immediately without asking any questions.

4.  As I was growing up, once family policy had been established, my 12345
mother discussed the reasoning behind the policy with the children in
the family.

5.  My mother has always encouraged verbal give-and-take whenever I 12345

have felt that family rules and restrictions were unreasonable.

6.  My mother has always felt that what her children need is to be free to 12345
make up their own minds and to do what they want to do, even if this
does not agree with what their parents might want.

7.  As I was growing up my mother did not allow me to question any 12345
decision she had made.

8.  As I was growing up my mother directed the activities and decisions 12345
of the children in the family through reasoning and discipline.

9.  My mother has always felt that more force should be used by parents 12345
in order to get their children to behave the way they are supposed to.

10.  As I was growing up my mother did not feel that I needed to obey 12345
rules and regulations of behavior simply because someone in authority
had established them.

11.  As I was growing up I knew what my mother expected of me in  12345

 my family, but I also felt free to discuss those expectations with my
mother when I felt that they were unreasonable.

12.  My mother felt that wise parents should teach their children early just 12345
who is boss in the family.

13.  As I was growing up, my mother seldom gave me expectations and 12345
guidelines for my behavior.

14.  Most of the time as I was growing up my mother did what the children 12345
in the family wanted when making family decisions.

15.  As the children in my family were growing up, my mother 12345

consistently gave us direction and guidance in rational and objective
ways.

16.  As I was growing up my mother would get very upset if I tried to 12345
disagree with her.

17.  My mother feels that most problems in society would be solved if 12345
parents would not restrict their children’s activities, decisions, and
desires as they are growing up.

18.  As I was growing up my mother let me know what behavior she 12345
expected of me, and if I didn’t meet those expectations, she punished
me.

19.  As I was growing up my mother allowed me to decide most things for 12345
myself without a lot of direction from her.

20.  As I was growing up my mother took the children’s opinions into 12345
consideration when making family decisions, but she would not
decide for something simply because the children wanted it.

21.  My mother did not view herself as responsible for directing and 12345
guiding my behavior as I was growing up.

22.  My mother had clear standards of behavior for the children in our 12345
home as I was growing up, but she was willing to adjust those
standards to the needs of each of the individual children in the family.

23.  My mother gave me direction for my behavior and activities as I was 12345
growing up and she expected me to follow her direction, but she was
always willing to listen to my concerns and to discuss that direction
with me.

24.  As I was growing up my mother allowed me to form my own point of 12345

view on family matters and she generally allowed me to decide for
myself what I was going to do.

25.  My mother has always felt that most problems in society would be 12345
solved if we could get parents to strictly and forcibly deal with their
 children when they don’t do what they are supposed to as they are
growing up.

26.  As I was growing up my mother often told me exactly what she 12345
wanted me to do and how she expected me to do it.

27.  As I was growing up my mother gave me clear direction for my 12345

behaviors and activities, but she was also understanding when I
disagreed with her.

28.  As I was growing up my mother did not direct the behaviors, 12345
activities, and desires of the children in the family.

29.  As I was growing up I knew what my mother expected of me in the 12345

family and she insisted that I conform to those expectations simply out
of respect for her authority.

30.  As I was growing up, if my mother made a decision in the family that 12345
hurt me, she was willing to discuss that decision with me and to admit
it if she had made a mistake.

Description: The PAQ is designed to measure parental authority, or disciplinary practices,

from the point of view of the child (of any age). The PAQ has three subscales: permissive
(P: items 1, 6, 10, 13, 14, 17, 19, 21, 24 and 28), authoritarian (A: items 2, 3, 7, 9, 12, 16,
18, 25, 26 and 29), and authoritative/flexible (F: items 4, 5, 8, 11, 15, 20, 22, 23, 27, and
30). Mother and father forms of the assessment are identical except for references to
gender. 

Scoring: The PAQ is scored easily by summing the individual items to comprise the
subscale scores. Scores on each subscale range from 10 to 50. 

Author: Dr. John R. Buri, Department of Psychology, University of St. Thomas, 2115
Summit Avenue, St. Paul, MN 55105. 

Source: Buri, J.R. (1991). Parental Authority Questionnaire, Journal of Personality and
Social Assessment, 57, 110-119.

BSMAS

Instructions: Below you find some questions about your relationship to and use of social
media use (Facebook, Twitter, Instagram and the like). Choose the response alternative for
each question that best describes you. Use the following scale:
1=Very rarely
2=Rarely
3=Sometimes
4=Often
5=Very often

How often during the last year have you…….

spent a lot of time thinking about social media or planned use of social media?
felt an urge to use social media more and more?
used social media to forget about your problems?
tried to cut down on the use of social media without success?
become restless or troubled if you have been prohibited from using social media?
used social media so much that it has had a negative impact on your job/studies?