Consent Form for Participation in a Research

Sultan Ageng Tirtayasa University

Promoting Composition of Students Having Writing Anxiety
Through Literature Circles

Description of the research and your participation

You are invited to participate in a research conducted by Arif Husein Lubis, a bachelor
student at Sultan Ageng Tirtayasa University. The purpose of this research is to find out
how Literature Circles promote composition process.
Your participation will involve in freedom-based reading discussions and in your point of
views toward this facilitation program.
Risks and discomforts
There are no known risks associated with this research. However, this study will require
you to do certain works concerning to the process of composing writing, such as:
personal journal through role sheets, summary writing (synopsis) related to reading genre
of your own circles.
Potential benefits
This study practically promotes both composition process and its quality concerning to
linguistic items, such as: cohesion, coherence, and word selection.
Protection of confidentiality
I will do everything for your privacy. Your identity will not be revealed in any
publication resulting from this study. Thus, the names written down in my study will be
completely pseudonym.
Voluntary participation
Your participation in this research study is voluntary. You may choose not to participate,
and you may withdraw your consent to participate at any time. You will not be penalized
in any way if you decide not to participate or to withdraw from this study.
Contact information
If you have any questions, concerns, and problems about this study, feel free to contact
Arif Husein Lubis at 085697578722.

Statement of Consent: I have read the above information, and have received answers to
any questions I asked. I consent to take part in the study.
Your Signature ___________________________________ Date __________________
Your Names (printed)
Dirman
In addition to agreeing to participate, I also consent to having the interview tape recorded.
Your Signature ___________________________________ Date ___________________
A copy of this consent form should be given to you.

Consent Form for Participation in a Research

Sultan Ageng Tirtayasa University
Promoting Composition of Students Having Writing Anxiety
Through Literature Circles

Description of the research and your participation

You are invited to participate in a research conducted by Arif Husein Lubis, a bachelor
student at Sultan Ageng Tirtayasa University. The purpose of this research is to find out
how Literature Circles promote composition process.
Your participation will involve in freedom-based reading discussions and in your point of
views toward this facilitation program.
Risks and discomforts
There are no known risks associated with this research. However, this study will require
you to do certain works concerning to the process of composing writing, such as:
circle worksheets, summary writing (synopsis), and personal journal related to reading
genre of your own circle.
Potential benefits
This study practically promotes both composition process and its quality concerning to
linguistic items, such as: cohesion, coherence, and word selection.
Protection of confidentiality
I will do everything for your privacy. Your identity will not be revealed in any
publication resulting from this study. Thus, the names written down in my study will be
completely pseudonym.
Voluntary participation
Your participation in this research study is voluntary. You may choose not to participate,
and you may withdraw your consent to participate at any time. You will not be penalized
in any way if you decide not to participate or to withdraw from this study.
Contact information
If you have any questions, concerns, and problems about this study, feel free to contact
Arif Husein Lubis at 085697578722.

Statement of Consent: I have read the above information, and have received answers to
any questions I asked. I consent to take part in the study.
Your Signature ___________________________________ Date __________________
Your Names (printed)
Circle two: HS, AK, D, AN, DWI, D
In addition to agreeing to participate, I also consent to having the interview tape recorded.
Your Signature ___________________________________ Date ___________________
A copy of this consent form should be given to you.

Consent Form for Participation in a Research

Sultan Ageng Tirtayasa University
Promoting Composition of Students Having Writing Anxiety
Through Literature Circles

Description of the research and your participation

You are invited to participate in a research conducted by Arif Husein Lubis, a bachelor
student at Sultan Ageng Tirtayasa University. The purpose of this research is to find out
how Literature Circles promote composition process.
Your participation will involve in freedom-based reading discussions and in your point of
views toward this facilitation program.
Risks and discomforts
There are no known risks associated with this research. However, this study will require
you to do certain works concerning to the process of composing writing, such as:
circle worksheets, summary writing (synopsis), and personal journal related to reading
genre of your own circle.
Potential benefits
This study practically promotes both composition process and its quality concerning to
linguistic items, such as: cohesion, coherence, and word selection.
Protection of confidentiality
I will do everything for your privacy. Your identity will not be revealed in any
publication resulting from this study. Thus, the names written down in my study will be
completely pseudonym.
Voluntary participation
Your participation in this research study is voluntary. You may choose not to participate,
and you may withdraw your consent to participate at any time. You will not be penalized
in any way if you decide not to participate or to withdraw from this study.
Contact information
If you have any questions, concerns, and problems about this study, feel free to contact
Arif Husein Lubis at 085697578722.

Statement of Consent: I have read the above information, and have received answers to
any questions I asked. I consent to take part in the study.
Your Signature ___________________________________ Date __________________
Your Names (printed)
Circle three: B, FDM, DW, BPK, DJ
In addition to agreeing to participate, I also consent to having the interview tape recorded.
Your Signature ___________________________________ Date ___________________
A copy of this consent form should be given to you.

Consent Form for Participation in a Research

Sultan Ageng Tirtayasa University
Promoting Composition of Students Having Writing Anxiety
Through Literature Circles

Description of the research and your participation

You are invited to participate in a research conducted by Arif Husein Lubis, a bachelor
student at Sultan Ageng Tirtayasa University. The purpose of this research is to find out
how Literature Circles promote composition process.
Your participation will involve in freedom-based reading discussions and in your point of
views toward this facilitation program.
Risks and discomforts
There are no known risks associated with this research. However, this study will require
you to do certain works concerning to the process of composing writing, such as:
circle worksheets, summary writing (synopsis), and personal journal related to reading
genre of your own circle.
Potential benefits
This study practically promotes both composition process and its quality concerning to
linguistic items, such as: cohesion, coherence, and word selection.
Protection of confidentiality
I will do everything for your privacy. Your identity will not be revealed in any
publication resulting from this study. Thus, the names written down in my study will be
completely pseudonym.
Voluntary participation
Your participation in this research study is voluntary. You may choose not to participate,
and you may withdraw your consent to participate at any time. You will not be penalized
in any way if you decide not to participate or to withdraw from this study.
Contact information
If you have any questions, concerns, and problems about this study, feel free to contact
Arif Husein Lubis at 085697578722.

Statement of Consent: I have read the above information, and have received answers to
any questions I asked. I consent to take part in the study.
Your Signature ___________________________________ Date __________________
Your Names (printed)
Circle four: DA, NT, FH, HN, AY, DDF
In addition to agreeing to participate, I also consent to having the interview tape recorded.
Your Signature ___________________________________ Date ___________________
A copy of this consent form should be given to you.

Consent Form for Participation in a Research

Sultan Ageng Tirtayasa University
Promoting Composition of Students Having Writing Anxiety
Through Literature Circles

Description of the research and your participation

You are invited to participate in a research conducted by Arif Husein Lubis, a bachelor
student at Sultan Ageng Tirtayasa University. The purpose of this research is to find out
how Literature Circles promote composition process.
Your participation will involve in freedom-based reading discussions and in your point of
views toward this facilitation program.
Risks and discomforts
There are no known risks associated with this research. However, this study will require
you to do certain works concerning to the process of composing writing, such as:
circle worksheets, summary writing (synopsis), and personal journal related to reading
genre of your own circle.
Potential benefits
This study practically promotes both composition process and its quality concerning to
linguistic items, such as: cohesion, coherence, and word selection.
Protection of confidentiality
I will do everything for your privacy. Your identity will not be revealed in any
publication resulting from this study. Thus, the names written down in my study will be
completely pseudonym.
Voluntary participation
Your participation in this research study is voluntary. You may choose not to participate,
and you may withdraw your consent to participate at any time. You will not be penalized
in any way if you decide not to participate or to withdraw from this study.
Contact information
If you have any questions, concerns, and problems about this study, feel free to contact
Arif Husein Lubis at 085697578722.

Statement of Consent: I have read the above information, and have received answers to
any questions I asked. I consent to take part in the study.
Your Signature ___________________________________ Date __________________
Your Names (printed)
Circle five: AB, H, D, H, AH, EY
In addition to agreeing to participate, I also consent to having the interview tape recorded.
Your Signature ___________________________________ Date ___________________
A copy of this consent form should be given to you.