Welcome to the: Loss of Blood-Related or Fictive Kin Sibling to a Violent Crime Survey

Please read this consent form carefully

This consent form contains important information to help you decide whether to participate in this survey

After reading the information in this consent form you should know:
  • Why this research survey is being done
  • What will happen during the survey
  • The possible risks to you
  • Resources available to you in the event you become uncomfortable during the survey 
  • How your personal information will be treated during, and after the survey
  • What to do if you have problems or questions about this survey
Online Consent Form

You are invited to take part in a research survey about the loss of a blood related or fictive kin sibling to violent crime. The purpose of the survey is to investigate how the death of a blood related or fictive kin sibling to violence affects the mental, emotional, physical, and financial health of the surviving sibling.

Your participation will require approximately 20-30 minutes and is completed online at your computer. While there are no known risks or discomforts associated with this survey, due to the sensitive subject matter, and your relationship to the deceased person, this survey involves questions that may surface memories that can potentially cause emotional pain. In the event you become emotionally distraught while taking the survey, stop taking the survey, and contact, Behavioral Health Response (BHR) at 1-800-811-4760 for 24-hour access to a clinician, or your personal therapist or counselor to speak with someone immediately.

Taking part in this study is completely voluntary. If you choose to be in the study you can withdraw at any time without consequence. Your responses will be kept strictly confidential, and digital data will be stored in secure computer files. Any report of this research that is made available to the public will not include your name or any other individual information by which you could be identified. If you have questions or want a copy or summary of this study’s results, you can contact the researcher, Cheeraz Gormon at info@siblingsupportnetwork.org. If you have any questions about whether you have been treated in an illegal or unethical way, contact St. Louis Community College, Human Subject Research Board, https://www.stlcc.edu./About/Institutional_Research_and_Planning/HSRB.html Please feel free to print a copy of this consent page to keep for your records.
For further details regarding how SurveyMonkey protects your personal data please ready the SurveyMonkey Privacy Policy. Any personal data collected from you in the survey may be transferred to various countries, including the United States and other locations in which SurveyMonkey has offices. See office locations

Question Title

* 1. By clicking ‘YES.’ you are confirming that you are 18-years of age or older, have received information to contact in case of mental and/or emotional health emergency, that the death of your sibling has taken place 12-months or more from the date you are taking the survey, and you have consulted with your therapist, counselor, or psychiatrist, that you are in good condition to take the survey, and indicates your consent to above terms, and to answer the questions in the survey.