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Consent to Participate in Online Research Study 
Identification of Investigator and Purpose of Study 
You are invited to participate in a research study, entitled “New Jersey Traumatic Brain Injury Needs Assessment.”  The study is being conducted by Brain Injury Alliance of New Jersey, 825 Georges Rd, North Brunswick, NJ 08902. 
The purpose of this research study is to examine the gaps in services for survivors and care givers of traumatic brain injury in the state. Your participation in the study will contribute to a better understanding of what we can do to improve the quality of life of TBI survivors and caregivers.  You are free to contact the investigator at the address and phone number below to discuss the study.  You must be at least 18 years old to participate. 
If you agree to participate: 
·  The survey will take approximately 15-30 minutes of your time. 
·  You will complete a survey about services for traumatic brain injury. 
·  You will not be compensated. However, upon completion of the survey you may choose to enter a pool to win a $10 gift card.

Risks/Benefits/Confidentiality of Data 
There are no known risks.  There will be no costs for participating, nor will you benefit from participating.  Your name and email address will not be kept on file. The answers you provide will be kept only during the data collection phase of the study on a secure computer file.  A limited number of research team members will have access to the data during data collection.  Identifying information will be stripped from the final dataset. 

Participation or Withdrawal 
Your participation in this study is voluntary. You may decline to answer any question and you have the right to withdraw from participation at any time. Withdrawal will not affect your relationship with BIANJ in any way. If you do not want to participate either simply stop participating or close the browser window.

If you do not want to receive any more reminders, you may email us at 

If you have any questions about the study or need to update your email address, contact Sakina Ladha at 609-480-2271 or send an email to This study has been reviewed by The Rowan University Institutional Review Board and the study number is PRO-2022-310.  

Questions about your rights as a research participant 

If you have any questions about your rights as a research subject, please contact the Office of Research Compliance at (856) 256-4078– Glassboro/CMSRU. 
If you agree to participate, please continue taking the survey.  
Thank you.    
Please print a copy of this document for your records.

Question Title

* 1. Do you provide care to a person with TBI?