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Community Dialogues – Consent Form & Registration

Thank you for your interest in applying to the Consent-Based Siting (CBS) Community Dialogue. Please read the information below before registering.

My name is Nicholas Weller and I’m a professor at Arizona State University. A team of researchers and I are conducting a research study funded by the U.S. Department of Energy to collect public views about community priorities and concerns. Specifically, we hope to understand how communities hope to make big decisions about critical challenges, like how to make fair decisions about where to store radioactive waste.

We invite you to respond to this approximately 5-minute questionnaire to provide demographic information and to learn about your experiences in your community. We will choose 15-20 people who answer this questionnaire to participate in a community dialogue. If invited, the community dialogue will take approximately 4-5 hours. You’ll share your experiences and preferences with other community members present and fill out a short workbook about your perspectives, which will take about 30 minutes of the total 4-5 hours. Your participation in both the questionnaire and (if invited) the community dialogue and workbook is voluntary. If you are invited and participate in the community dialogue, you will receive a $100 gift card.

During the dialogue, discussions and individual responses will be recorded via voice recorder, written notes, and participant workbooks. All recordings, notes, and worksheets will be kept in a secure location and be used only by the researchers to further our understanding of the deliberations that take place and to fully explore participant perspectives. Personally identifiable information removed will be removed from the recordings, notes, and participant workbooks.

The questionnaire asks for your name and email address. These will only be used to confirm your participation and send event information for the community dialogue. Your name and contact information will be removed from your questionnaire responses after the community dialogue event.

The results of this study may be used in reports, presentations, or publications but your name will not be known. Most results will only be shared in the aggregate form and any individual comments will be anonymized. De-identified data collected as part of the current study may be shared with other researchers for future research purposes. Because other participants will be at the community dialogue, complete confidentiality of your responses at the community dialogue cannot be guaranteed.

If you have any questions concerning the research study, please contact the research team at: or 520-236-7611. If you have any questions about your rights as a subject/participant in this research, or if you feel you have been placed at risk, you can contact the Chair of the Human Subjects Institutional Review Board, through the ASU Office of Research Integrity and Assurance at (480) 965-6788.

Question Title

* 1. I agree to the following:

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