Community Resilience Research Consent Form
Please review the consent information and provide your details to participate in this community resilience research study.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Age
*
Gender
Female
Male
Non-binary
Prefer not to say
Other
City or Community of Residence
*
How long have you lived in your current community?
*
Please Select
Less than 1 year
1-5 years
6-10 years
More than 10 years
How would you rate your community's ability to recover from challenges (e.g., natural disasters, economic downturns)?
*
1
2
3
4
5
Which of the following resources are available in your community? (Select all that apply)
Emergency shelters
Community health services
Volunteer organizations
Local government support
Other
In your own words, please describe a time when your community faced a significant challenge and how it responded.
Please sign below to confirm your consent and participation.
*
Submit Consent
Submit Consent
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