Consent Form (G4)

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Date: November 9, 2022

Dear Senior High School Students of Angels in Heaven School,

SUBJECT: INVITATION TO PARTICIPATE AS A RESPONDENT

We are inviting you to participate in our research entitled, Impact of Mobile Phone Usage on
Academic Performances of Angelian SHS Students. This study aims to investigate the
relationship between mobile phone usage and senior high school students’ academic
performances. Understanding and interpreting the effects of using mobile to improve academic
performance.

This is entirely voluntary, and you may withdraw from the study at any time should any of your
standards and conditions be violated. Rest assured that all of the information collected will also
be kept confidential and strictly used for academic purposes only.

If you have any questions regarding our research, please do not hesitate to contact me via text
message at 916-210-0354 or email me at johnmendoza649@yahoo.com .

Thank you for your time, and we hope for a favorable response to our request.

Respectfully yours, Noted by:

John Raszel Braga Mendoza Ms. Dianne D. Clemente


Group Leader Research Instructor
Consent to Participate in a Research Study

Title of Research: Impact of Mobile Phone Usage on Academic Performances of Angelian SHS
Students
Researchers: John Raszel Mendoza, Mary Merced Arimuhanan, Karen Antonio Lazaga, Ysabela
Ysha Robles
Affiliation: Angels in Heaven School
Email: johnmendoza649@yahoo.com
Contact No.: 916 210 0354

CONFIDENTIALITY
This study is anonymous. Your personal identity and other information will not be collected nor
retained. The records of the study will be kept strictly confidential. All information, including
survey-questionnaire forms and demographic profiles, will only be accessible to the researchers
and will be used strictly for research purposes only.

RIGHT TO REFUSE OR WITHDRAW


The decision to participate will be entirely up to your decision. Your refusal will not affect your
relationship with the research team of this study. You are entitled to withdraw completely from the
research study at any point during the process.

RIGHT TO ASK QUESTIONS AND REPORT CONCERNS


You have the right to ask questions about this research study and have those questions answered by
the researchers before, during, and after the research. If you have further questions about this study,
feel free to contact us.

CONSENT:
Your signature indicates that you decided to consent to be a respondent in the study and that you
have understood the terms and agreement in conducting the research procedures.

Respondent’s signature over printed name

Date

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