We Hear You. Midland Racial/Equity Inclusion Consent Form

Project Title:
We Hear You. Midland Diversity and Inclusion Study.

Principal Investigators:
Ken Jolly, Ph.D.; Evelyn Ravuri, Ph.D.

Funded by:
Midland Area Community Foundation

Purpose of the Study:
The following survey is designed to assess your experiences with racial/ethnic (in)equity in Midland County. Through the collective voices of members of the Midland Community, agencies within Midland will be able to address issues of racial/ethnic inequity. We ask that you be of at least 18 years of age and a resident of Midland County.

You will be asked questions concerning your economic, social, and healthcare well-being at the beginning of the survey. This allows us a baseline for assessing ‘well-being’ by racial/ethnic group. You will then be asked a series of questions concerning your experiences with racial/ethnic interactions in Midland County. Lastly, we ask about your experiences with law enforcement agencies in Midland County. Each of these questions requires selecting an answer that most fits with your situation/experience. Please answer the survey based upon your personal experiences.  Several of the questions allow for written comments if desired. The survey should take about 25 minutes.

Possible Risks:
We anticipate risks to be minimal. In several cases respondents may feel somewhat uncomfortable answering a question. The respondent may skip any question which makes them uncomfortable. If the respondent still feels uncomfortable, the respondent may withdraw from the survey.

Participant Rights:
If you choose to be in this study, you have the right to be treated with respect, including respect for your decision whether or not you wish to continue or stop being in the study. You are free to stop being in the study at any time.  

Benefits of Participating in Study:
You will be able to relate your experiences and voice your concerns about racial/ethnic equity in Midland County. The aggregate results of the survey will guide Midland County agencies in improving racial/ethnic relations within Midland County.

Your responses to this survey will remain anonymous. There is no identifying data to trace your responses on this survey back to you. “It is possible that the Institutional Review Board (IRB) may view this study’s collected data for auditing purposes. The IRB is responsible for the oversight of the protection of human subjects involved in research.”

Questions or Concerns about this Research Study:
If you have any questions concerning this survey, contact us promptly. You can email Evelyn (eravuri@svsu.edu), Ken (kjolly@svsu.edu), or Diane Brown Wilhelm (dbrown@midland-mi.org) with questions about this research. You may also contact the Chair, Human Subjects Institutional Review Board (989-964-7488; irbchair@svsu.edu) if questions or problems arise during the course of the study.

Question Title

* 1. I have read the information  presented above regarding the We Hear You Survey, I am at least 18 years of age, and I consent to using my responses in the survey.