American Civic Survey English

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1. Consent Form

The American Civic Association and Binghamton University are doing a survey; a survey is a special way to find out about something. We are trying to find out about the needs of the people who use the services here. If you want to be in this study, we will ask you to answer the following survey about yourself.
This survey will last 7 to 10 minutes. Not everyone in the study will have something helpful happen to them, but we hope to learn something that will help other people some day.
If a report is written or anyone else is given information about you, they will not know your name. If you do a paper survey we will provide a room for you to complete the survey in privacy. Once you complete the survey please put it in the envelope given to you and place it in the box at the front desk. If any survey question makes you uncomfortable, you can refuse the survey or choose prefer not to answer
Before you check the form, please ask questions on any aspect of the study that is at all unclear to you. If you have any additional questions later, Andrew Baranoski will be happy to answer them. If at any time you have questions concerning your rights as a research subject you may call Binghamton University's Human Subject's Research Review Committee at (607) 777-3818. You will be given a copy of this form to keep.
You do not have to be in this study. If you decide to be in the study, but change your mind, you can stop being in the study. If you do not want to be in this study, we will tell you about the other things we can do for you.

If you want to be in this study, check the box below.

Consent Form The American Civic Association and Binghamton University are doing a survey; a survey is a special way to find out about something. We are trying to find out about the needs of the people who use the services here. If you want to be in this study, we will ask you to answer the following survey about yourself. This survey will last 7 to 10 minutes. Not everyone in the study will have something helpful happen to them, but we hope to learn something that will help other people some day. If a report is written or anyone else is given information about you, they will not know your name. If you do a paper survey we will provide a room for you to complete the survey in privacy. Once you complete the survey please put it in the envelope given to you and place it in the box at the front desk. If any survey question makes you uncomfortable, you can refuse the survey or choose prefer not to answer Before you check the form, please ask questions on any aspect of the study that is at all unclear to you. If you have any additional questions later, Andrew Baranoski will be happy to answer them. If at any time you have questions concerning your rights as a research subject you may call Binghamton University's Human Subject's Research Review Committee at (607) 777-3818. You will be given a copy of this form to keep. You do not have to be in this study. If you decide to be in the study, but change your mind, you can stop being in the study. If you do not want to be in this study, we will tell you about the other things we can do for you. If you want to be in this study, check the box below.   I agree I do not agree