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ONLINE SURVEY CONSENT FORM
Title of Research Study: CARE Intake Screener Study

Researcher's Contact Information: 

Marcy Stidum, LCSW, MPA 470-578-5260 mstidum@kennesaw.edu 
Carrie Olsen, LCSW 470-578-5260 colsen1@kennesaw.edu 
Matt Khoury 470-578-2712 mkhoury1@kennesaw.edu 
Kristen Byers, Graduate Intern kbyers@kennesaw.edu

Introduction 
You are being invited to take part in a research study conducted by CARE Services of Kennesaw State University. Before you decide to participate in this study, you should read this form and ask questions about anything that you do not understand. 

  • The purpose of this study is to use the information gathered from the intake screener survey that students complete to see if they qualify for services and make an initial appointment with Kennesaw State University’s CARE (Campus Awareness, Resource & Empowerment) Services to inform future service delivery. Findings will show trends in the referral process and in the types of services homeless, foster care, and food insecure student populations are seeking, and will serve as a benchmark for program design.

  • You will be asked to complete a brief online survey regarding the reason for your referral to CARE Services. 

  • The survey will take 5-10 minutes to complete. 

  • There may be risk or discomfort associated with reviewing the original reason for reaching out to CARE Services.

  • Although there will be no direct benefits to you for taking part in the study, the researcher may learn more about how to better serve CARE students in the future. 

  • Not applicable.

  • The results of this participation will be confidential and collected online. Internet Protocol addresses WILL NOT be collected by the survey program. The participants’ KSU IDs, emails, and names will ONLY be collected for the purpose of making an intake appointment with a CARE Case Manager. A detailed summary of each response will be provided to CARE Services and any identifying information will be stored within the Navigate online advising system for each participant's individual file. Only CARE staff and the researchers listed will have access to information gathered from this survey. Data will be compiled in Formstack and identifying information will be excluded from collected data.

  • Students who are expressing interest in receiving services from KSU CARE Services, and who are over the age of 18 will be invited to participate.

  • Internet Protocol addresses WILL NOT be collected by the survey program.

Research at Kennesaw State University that involves human participants is carried out under the oversight of an Institutional Review Board.  Questions or problems regarding these activities should be addressed to the Institutional Review Board, Kennesaw State University, 585 Cobb Avenue, KH3417, Kennesaw, GA 30144-5591, (470) 578-6407.

 

PLEASE PRINT A COPY OF THIS CONSENT DOCUMENT FOR YOUR RECORDS, OR IF YOU DO NOT HAVE PRINT CAPABILITIES, YOU MAY CONTACT THE RESEARCHER TO OBTAIN A COPY. PDF OF THE DOCUMENT CAN BE FOUND HERE.

***PARTICIPATION IN THE STUDY IS NOT A REQUIREMENT FOR COMPLETING THE QUESTIONS TO DETERMINE CARE ELIGIBILITY.

I agree and give my consent to participate in this research project. I understand that participation is voluntary and that I may withdraw my consent at any time without penalty.

 

I do not agree to participate and will be excluded from data collection for the purpose of this study.

 

 

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