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Comprehensive Wellness Survey for People with Disabilities

Survey Consent Form

Consent Form: Comprehensive Wellness Survey for People with Disabilities 

The purpose of this research project is  to measure different areas of well-being for people living with disabilities in the United States of America. This research project is being conducted by Gaelynn Lea, a Disability Rights advocate, musician, and public speaker from Duluth, Minnesota. This is an ongoing study - feel free to share it with other members of the disability community so that everyone who wants to can make their voices heard. Gaelynn is planning to publish the results of this survey in a book and/or academic journal in the coming years. 

Your participation in this research study is voluntary. You will be asked to complete an online survey that will take approximately 25 minutes. If you have trouble reading, it's okay to have help or to have someone read the survey out loud to you.

The following survey questions will be about living with a disability in America. Some of the questions will pertain to issues such as substance abuse, mental health, and victimization history. You can choose not to disclose the information requested about these topics if they are distressing to you. This survey is written in a multiple choice format, but under most sections there is a comment section where you can enter additional information or examples from your life that illustrate the concepts being addressed in the corresponding question. This is because Gaelynn Lea wants you to have the opportunity to share your wealth of unique experiences. However, these additional examples are OPTIONAL. If you don't want to provide more information, simply leave the comment boxes blank.

Please know that any additional examples or stories you provide in the comment boxes may be used in future reports, presentations, and/or publications, although your identity will be kept confidential. No names will be used in future work with these survey results.  Gaelynn Lea will do her best to keep your information confidential. All data is stored in a password protected electronic format. To help protect your confidentiality, the surveys will not contain information that will personally identify you.

The results of this study will be used by Gaelynn Lea for scholarly purposes. A summary of the survey results will be available at her website once she has analyzed the preliminary data, and will be periodically updated as new data is collected. If you have any questions about the research study, please contact Gaelynn Lea at  *This question is required.