Interest Form

You were contacted because you have been identified as someone who may meet our inclusion criteria. This study is looking at how having a sibling with a disability affects mental health. If you are still interested in participating, please fill out the questions below. If you have questions that you would like answered, please contact us:

Rebecca Abel and Sienna Miley

Email: smiley@gm.slc.edu

Phone: 518-937-7520

Question Title

* 1. What is your first name?

Question Title

* 2. How old are you?

Question Title

* 3. What is your email?

Question Title

* 4. What is your parents email?

Question Title

* 5. What is a good phone number to reach you at?

Question Title

* 6. We plan on using email as the main contact method. Does this work for you?

Yes

Question Title

* 7. Please select the following that apply to you:

I am between the ages of 13 and 18

I have a sibling with a chromosome 18 difference/anomaly

My sibling with a chromosome 18 difference/anomaly lives at home with me

Question Title

* 8. Please describe your sibling's disability.

Question Title

* 9. Do you have a disability?

Yes

Interest Form

Interest Form

Question Title

* 1. What is your first name?

Question Title

* 2. How old are you?

Question Title

* 3. What is your email?

Question Title

* 4. What is your parents email?

Question Title

* 5. What is a good phone number to reach you at?

Question Title

* 6. We plan on using email as the main contact method. Does this work for you?

Question Title

* 7. Please select the following that apply to you:

Question Title

* 8. Please describe your sibling's disability.

Question Title

* 9. Do you have a disability?

Question Title

* 10. If yes, please describe.