Consent Form

This survey is being independently conducted by Southern Illinois University at the request of the Carbondale City Council. Participation is voluntary, but I hope that you will help and take the opportunity to share your opinion and experiences about gun violence in the city. Your experiences and opinions are valuable to improving understanding about the problem, and we are grateful if you are willing to share them with us. There are no specific risks or benefits to you to doing so. It takes only 8-10 minutes to complete.
Your responses are anonymous, individuals cannot be identified. Only summary statistics will be included in a report to the council. You may skip any question or stop taking the survey at any time. We will attempt to integrate responses even from partially completed surveys into our report, when possible.
If you have any questions or need assistance, please contact me, Dr. Tammy Kochel, Associate Dean in the College of Health and Human Sciences, at or (618) 453-6371—please leave a voice mail if I am unable to take your call, and someone will call you back.
This project has been reviewed and approved by the SIUC Institutional Review Board. Questions concerning your rights as a participant in this research may be addressed to the Committee Chairperson, Office of Research Compliance, Southern Illinois University, Carbondale, IL 62901-4709. Phone (618) 453-4534. E-mail
If you are 18 years or older, and you agree to take the survey, please click below to proceed: