Consent Form: Prevalence of Adverse Childhood Experiences in South Asian Communities in Minnesota

  • I agree to participate in the study entitled Prevalence of Adverse Childhood Experiences in South Asian Communities in Minnesota conducted by students from Carleton College, MN, under the supervision of Professor Debby Walser-Kuntz and Professor Neil Lutsky, in partnership with SEWA-AIFW.

  • I understand that my participation will include completing a 14-question multiple-choice survey on different types of abuse, neglect, and other potentially traumatic experiences I may have experienced before the age of 18. The survey will take approximately 15 minutes in total. I understand that my participation in this study is strictly voluntary, and that there will be no penalty if I decide not to participate, or to discontinue participating, which I may do at any time. 

  • I understand that I may decline to answer any question without consequence, and that I am free to withdraw from the study at any time I wish to, without having to provide a reason.

  • I understand that my name will not be recorded together with my data and that I can use the Unique Identifier I enter on the form at the start of the survey to anonymously request deletion of all my responses at any point before manuscript submission begins on 6 January 2021, after which time it may not be possible for my responses to be deleted.

  • I understand that I am only eligible to participate if I am 18 years of age or older due to federal and state regulations regarding the ability to provide signed consent for oneself.

  • I understand that after 6 January 2021 the data collected in this study may be submitted to an academic journal and may be passed along to other qualified researchers at other colleges and universities who may want to use it for further analysis. The data will remain unlinked, and no means of identifying me will be provided to any future researcher in any event. 

  • I understand that I will not receive compensation for my participation.

  • If you have any questions or concerns regarding this study and would like to talk to someone other than the researcher(s), contact the Institutional Review Board for Research with Human Subjects at Carleton College, c/o Office of the Associate Dean of the College, Carleton College, One North college Street, Northfield MN, 55057; Telephone (507) 222-4301.

By clicking "Take the Survey", I acknowledge that I have fully read and understood all the information on the Consent Form and Information Sheet, and consent to participate in this survey.


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