This is written in both English and Japanese. 英語と日本語で書いてあります。

I am currently writing a thesis for the completion of the Japanese Language and Culture program at Kanazawa University. I am investigating the perceptions of the samurai held by the Japanese and non-Japanese University students. The contents and statistics of this questionnaire will be kept fully confidential and will not be used for any other purposes other than research. Thank you for your cooperation.
I will be very grateful if you will help me to pass this survey on to your friends. Thank you very much. http://www.instant.ly/s/CA3Ue

友達までにも配っていただけければ、心から感謝を申し上げます。よろしくお願いいたします。 http://www.instant.ly/s/CA3Ue

Special permission was asked to post this, and it was given :)