This survey is mainly targeted at persons with disabilities in Southern Africa. We are interested in understanding how the current COVID-19 crisis is affecting you and how you feel about the ongoing response interventions at the local community, national and even regional levels. The information gathered will greatly enhance SAFOD's own regional response strategy for persons with disabilities. We greatly appreciate you taking the time to share your thoughts.

*1.I agree to participate in the research study. I understand the purpose and nature of this study and I am participating voluntarily. I understand that I can withdraw from the study at any time, without any penalty or consequences.(Required.)

Yes

No

*2.I grant permission for the data generated from this interview to be used in the researcher's publications on this topic.(Required.)

Yes

No

I grant permission under the following conditions:

*3.Any information that is obtained in connection with this study and that can be identified with you will remain confidential and will be disclosed only with your permission. Choose one of the following options:(Required.)

I agree that a brief synopsis can be included in the documentation of the research, including my name, school/organization/business name and brief bio. I understand that I will be asked to provide a brief bio and that I will be asked to approve this synopsis. I understand that no other personal information will be communicated.

I prefer to remain anonymous and to have no professional information or organization or business name included in the researcher's publications based on this study.

*4.Please type your name in the box below to indicate agreement to participate in this study.(Required.)