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American Association for Public Opinion Research

Introductory Screen Content

TOPIC OF Survey 2003-2004

Conducted by the Office of

Thank you for participating in our online survey. We’re conducting this survey to obtain feedback regarding your experience with . We realize that answering personal questions about this topic may be uncomfortable for you. We remind you that your participation in this project is strictly voluntary and you may refuse to participate or discontinue participation at any time during the project without penalty. You may skip any questions you don’t wish to answer. If you decide to fill out the survey, all your responses will be kept strictly confidential and will only be seen by authorized members of our staff at the XXX Office of . You’re welcome to contact our office at any time if you have questions about the survey. You may also contact the XXXX IRB Office (xxx.xxx.xxxx; [email protected])with your questions about research participants’ rights.

Data gathered from the entire project will be summarized in the aggregate, excluding references to any individual responses. The aggregated results of our analysis will be shared with departments at the University of XXXXX and others interested in providing services to educate people about . Our office is looking for better ways to help people learn about , and to assist those who are concerned about . With your responses, we hope to identify areas that we need to improve or add to our services. Again, your input is very important to us and any information we receive from you will be kept secure and confidential.

The survey has five sections: YOUR EXPERIENCES, YOUR HABITS, WHAT DO YOU THINK, ABOUT YOU, and CONTACT INFORMATION. It will only take you about 10 minutes to complete. Once you’ve submitted the survey, an entry to our drawing will appear as a new page in your browser. Simply complete the form and click the Submit button to enter the drawing. Submitted entries to the drawing are stored separately from survey responses, so the two will not be linked. By entering the drawing, you will have a chance to win one of five $ STORE vouchers. Your chances of winning one of the prizes are greater than or equal to 5 in 2,000. Winners will be notified by DATE .Good luck!

Please direct any problems concerning the survey to [email protected]

This informed consent statement has been approved by the University of XXXXX until MO/DA/YEAR.

You are encouraged to print a copy of this statement for your records.