PhotoVoice #5: What noises in your home/neighborhood or work environment create physical or emotional discomfort for you or a family member?

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* 1. What noises in your home/neighborhood or work environment create physical or emotional discomfort for you or a family member?

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* 2. What is your name? (OPTIONAL)

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* 3. If you shared your name, do you want it visible to the public?

Yes

No

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* 4. Add a caption for your photo. This will be visible to the public on the website.

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* 5. Optional: Add a description of the picture that helps researchers better understand the context - but that you do not want to share with the public - (This will not be visible to the public- it will only be visible to community researchers)

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* 6. Do you give permission to the Community Perspectives Noise Pollution Researchers and the Cornell Lab of Ornithology to use your photograph/image for research and educational purposes in connection with the Photovoice Research Project? The photos will be displayed on the noiseproject.org website and may be used in community shows, and educational material (print and online).

Yes

No

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* 7. Photo Consent