Survey Consent Form

This form asks for your consent to participate in a community based research study on the neighborhood assets and needs in the Northwest Aurora and Stapleton neighborhoods and the potential impact by the Stanley Marketplace development project which, is part of the Westerly Creek Urban Renewal Plan.

The purpose of this research project is to pilot test a neighborhood asset development and needs assessment survey in the Northwest Aurora neighborhood of the suburb of Aurora, and the northeast Stapleton neighborhood of Denver. The neighborhood survey is developed to ascertain the degree and intensity of neighborhood collective efficacy, neighborhood economic, social, and political sustainability, and neighborhood collaboration between the Northwest Aurora and Stapleton neighborhood community organizations and the Stanley Marketplace. The neighborhood survey consists of 115 questions and should take no more than 20-40 minutes of your time.

The study is being conducted by Theodoric Manley, Jr. Ph.D., an Urban Sociologist and Intergroup Relations consultant. The risks associated with participation in this study are minimal and may include feelings of guilt, anger, defensiveness, embarrassment, and shame. These feelings may arise when completing the Northwest Aurora-Stapleton-Stanley Marketplace neighborhood survey. These feelings are normal and will usually dissipate over the course of completing the survey.

Please be informed that:

1. Your participation in the study is fully voluntary.

2. You have the right to stop participating at any time without any consequences.

3. All demographic information you provide will be kept strictly confidential, and any report of the demographic component of the research will not identify you in any way.

4. In signing this form (electronically or in person) you certify that you are 18 years of age or older.

If you have any questions, please feel free to ask them. And if you desire information in the future regarding specific information about the study feel free to contact the Principal Investigator Theodoric Manley, Jr. Ph.D. at (303) 278-2298 or email 

The first question on the survey requires your agreement and electronic signature to indicate you have read the information provided above and agree to voluntarily participant in this study.

Question Title

* 1. I have read the information provided in the Consent Form and agree to voluntarily participate in this study.