Disaster Relief Research Participation Consent Form
A participation consent form for a disaster relief research study. Please provide the requested information and review the participation consent carefully.
Participant Information
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method
*
Email
Phone
Disaster Context and Research Relevance
Disaster Type
*
Please Select
Hurricane
Flood
Earthquake
Wildfire
Tornado
Other
Approximate Date or Period of Disaster Exposure
*
Role or Experience Context Related to Disaster Relief
*
Data Use and Follow-up Preferences
Permission for follow-up contact
*
Yes, I agree to follow-up contact
No, do not contact me
Preferred follow-up timing
Please Select
Weekdays, 9:00 AM–5:00 PM
Evenings
Weekends
Any time
Prefer not to say
Comments or questions about participation
Submit
Should be Empty: