Consent

Question Title

* 1. Consent Form

The purpose of this research project is to explore the role of mentors and people with a spinal cord injury (SCI) and their return to work process. This research project will be conducted under the supervision of Dr. Debora Oliveira, Director of the Division of Occupational Therapy and Dr. Barbara Kornblau, Professor at Florida Agricultural & Mechanical University via SurveyMonkey. You are invited to participate in this research project because you have been diagnosed by a health professional with SCI, you are 18 or older, you currently live in the United States, and you work or have worked within the last 2 years.

Your participation in this research study is voluntary. You may choose not to participate. If you decide to participate in this research survey, you may withdraw at any time. If you decide not to participate in this study or if you withdraw from participating at any time, you will not be penalized.

The procedure involves filling an online survey that will take approximately 30 minutes. Your responses will be confidential and we do not collect identifying information such as your name, email address or IP address. The survey questions will be about your personal experience living with SCI. Due to the lack of current research available on this topic, this study will help students and others learn about the role of mentors from the perspective of people with spinal cord injuries (mentees) who are working or have worked within the past two years. There are minimal risks, however, you may feel some discomfort or stress because of the personal nature of the information you will be asked to provide when completing the online survey.

All data is stored in a password protected electronic format. To help protect your confidentiality, the surveys will not contain information that will personally identify you. The results of this study will be used for scholarly purposes only and may be shared with Florida A&M University representatives.

If you have any questions about the research study, please contact Dr. Debora Oliveira Ph. D., CRC, OTR/L at her campus address 334 Palmer Ave. Suite 306 Tallahassee, FL 32307,  or phone number 850-561-2010, or email address Debora.oliveira@famu.edu. Participants may also contact Dr. Angela Thornton at Room 308H Science Research Center, Tallahassee, FL 32307, or phone number850-412-5246, or email address angela.thornton@famu.edu. This research has been reviewed according to Florida Agricultural and Mechanical University’s IRB procedures for research involving human subjects.

ELECTRONIC CONSENT: Please select your choice below.

Clicking on the "agree" button below indicates that:

• you have read the above information

• you voluntarily agree to participate

• you are at least 18 years of age

 If you do not wish to participate in the research study, please decline participation by clicking on the "disagree" button.

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