KEY INFORMATION ABOUT THIS RESEARCH SURVEY:
The following is a short summary of this survey to help you decide whether you want your child to be a part of this survey. Information that is more detailed is listed later on in this form. The purpose of this survey is to assess the impact our mentors have on the youth who have been in our organization. Your child will be asked how they view/viewed mentor through 26 statements. For example: “My mentor sets a good example for me” and they will rate if that is “Not True at All” or “Very True”.  This survey will only last approximately 10 minutes. There is no risk for participation in this survey . The main benefit is to provide information on how mentors influence youth with a cancer diagnosis.

SURVEY PURPOSE:
The purpose of this survey is to assess the value of having a mentor in your child’s life whether it be during or after their treatment. Providing this information to hospitals and donor’s allows us to continue our mission.

PROCEDURES FOR THE SURVEY:
If you agree for your child to participate in the survey, they will receive a link to fill out the survey electronically. If you prefer a hard copy of the survey, it will be mailed to you with a return envelope.

RISKS AND INCONVENIENCES:
There are minimal risks and inconveniences to participating in this survey. These include: The time the child spends for participating in the survey might be considered an inconvenience.

CONFIDENTIALITY:
Your child’s responses will be confidential. Confidential is applicable when the researcher knows, collects, or has a record of the participant’s name or other identifiable information such as e-mail address, birthdate, but uses pseudonyms during reporting of the data, and the personal information is only accessed by the researcher or the research team who is doing the survey.

The results of this survey may be used in reports, presentations, or publications but your child’s name will not be used. The data will be stored in a password protected computer, only Connecting Champions staff will have access to the data. The data will be stored indefinitely within the organization.

VOLUNTARY PARTICIPATION:
Your child’s participation in this survey is voluntary. Your child may decline participation at any time. You may also withdraw your child from the survey at any time; there will be no penalty. Likewise, if your child chooses not to participate or to withdraw from the survey at any time, there will be no penalty.  

BENEFITS OF TAKING PART IN THE SURVEY:
Although there may be no direct benefit to your child, the possible benefit of your child’s participation is a better understanding of how their mentor may be helping them whether it be during or after their treatment.

PAYMENT OR INCENTIVE:
For participating in this survey, your child will receive a $10 Amazon gift card. The email address provided at the end of the survey is where the gift card will be sent to.


CONTACT INFORMATION:
If you have questions about the survey, please call Sloane at 304-278-4821 or e-mail at sloane@connectingchampions.org.