The Informed Consent Form

Purpose of the Study: This is a study for master thesis in psychology that is being
conducted by Vismaia Nurfitriani, in SWPS University of Social Sciences and
Humanities in Warsaw, Poland. The purpose of this study is to search for relationship
between your perceived knowledge about yourself and your ability to successfully
adapt to life task in everyday life.

What will be done: You are asked to check mark from the list below the adjectives
you would use to describe yourself (e.g., friendly, intelligent). Please include both
positive and negative adjectives. If there is an adjective you would use to describe
yourself and it is not included in the list, please write it at the end of the list in the
space provided. You can choose any adjectives as much as you want.

Example:
1. Caring
2. Comfortable
3. Confident
4. Creative

Risks or discomforts: No risks or discomforts are anticipated from taking part in this
study. If you feel uncomfortable with an item, you can skip that item or withdraw
from the study altogether. If you decide to quit at any time before you have finished
the lists, your answers will NOT be recorded.

Confidentiality: Your responses will be kept completely confidential. All data from
this study will be kept from inappropriate disclosure and will be accessible only to the
researcher and the faculty advisor.
Only the researcher will see your individual survey responses. Your particular
individual results are not going to be used, showed or shared anywhere. The
researcher is only interested in the results of the study performed on the whole
research group. These outcomes will be presented in author’s Master thesis and
possibly in some scientific articles or on conferences.

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Contact information: If you have concerns or questions about this study, please
contact Vismaia Nurfitriani at vismaianf@gmail.com or +48508552771. You may
obtain information about the outcome of the study at the end of the academic year by
contacting Vismaia Nurfitriani.

I have read this information and agree to participate in this research.

Date ______________ Signature ______________________

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POSITIVE 26. Sensitive
1. Caring
27. Successful
2. Comfortable
28. Kind
3. Confident
29. Religious
4. Creative
30. Capable
5. Cute
31. Calm
6. Determined
32. Caring
7. Easy Going
33. Family
8. Energetic
34. Diligent
9. Friendly
35. Educated
10. Fun And Entertaining
36. Pride
11. Funny
37. Obedient
12. Giving
38. Polite
13. Happy
39. Respectful
14. Hardworking
40. Success
15. Helpful
41. Competition
16. Honest
42. Down-to-earth
17. Independent
43. Smiling
18. Intelligent
44. Friendly
19. Kind
45. Tolerant
20. Loving
46. Forgiving
21. Mature
47. Patience
22. Optimistic
48. ……………………
23. Organized
49. ……………………
24. Outgoing
50. ……………………
25. Quiet

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NEGATIVE 13. Self-Centered
1. Bad Tempered
14. Short-Tempered
2. Disorganized
15. Shy
3. Easy To Get Angry
16. Stubborn
4. Immature
17. Uncomfortable
5. Impatient
18. Weary
6. Incompetent
19. Complaining
7. Indecisive
20. Embarrassment
8. Insecure
21. Worried
9. Irresponsible
22. Panic
10. Lazy
23. …………………
11. Passive-Aggressive
24. …………………
12. Sad And Blue
25. …………………