Community Research Board Survey

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Thank you for your interest in the Community Research Board (CRB).

We are a friendly, fun, and diverse group of parents that shares their opinions about genetic research and how to make it better for everyone. Even if you are very skeptical or concerned about it, we would really like to hear from you because these opinions are very important.

We are looking for new members who:
- can join a Zoom call on the second Thursday night of every month from 7:15 - 8:45 pm.

- have a social security number that UNC can use to set you up to pay you for your time. Compensation is $50/hr and more opportunities for paid participation are available.

- have a phone/computer with a camera and feel comfortable talking and respecting other viewpoints on Zoom

Your information on this quick survey will be kept private and used to contact you. You will hear from us within 1 week.

We will NOT ask you to participate in any type of genetic testing. For more information, visit go.unc.edu/abgs or email laura_milko@med.unc.edu.

Email *

Please provide your full name *

What sex were you assigned at birth, on your original birth certificate? (Check one) *

Female

Male

Prefer not to answer

What is your age? *

What is your child's (or children's) age(s)? *

What category or categories best describe you? Check all that apply. *

American Indian, Native American, or Alaska Native

Asian

Black or African American

Native Hawaiian/Pacific Islander

White or European American

Middle Eastern or North African/Mediterranean

Hispanic/Latino(a)

Prefer not to answer

Unknown/none of these fully describe me

Required

What is the highest grade or level of school you completed or the highest degree you received? (Check one) *

Less than high school (less than 9th grade)

Some high school (9th to 12th grade), no diploma

High school graduate (diploma or GED or equivalent)

Some post-high school training (college or occupational, technical, or vocational training), no degree or certificate

Associate (2-year) college degree, or completed occupational, technical, or vocational program and received degree or certificate

Bachelor’s degree (for example: BA, AB, BS)

Graduate or professional degree (for example: MA, MBA, JD, MD, PhD)

Required

What kind or kinds of health insurance or health care coverage do your children have? (Check all that apply) *

Private health insurance, (e.g. employment-based, exchange-based)

Government plan, (e.g. Medicaid, CHIP, TRICARE)

No coverage of any type

Required

Do you live and work in a primarily urban, suburban, or rural setting? *

Do you have a child who has undergone testing for a genetic condition? *

Yes

How receptive are you to the idea of genetic testing for your child(ren) during regular pediatric check-ups if it could detect a genetic condition early enough to either prevent it or diminish its severity? *

Very non-receptive

Somewhat non-receptive

Neither receptive nor non-receptive -or- I don't know

Somewhat receptive

Very receptive

Do you have a child or children with a genetic condition or special medical needs? *

Yes

If you selected yes for the previous question and are comfortable sharing what that condition is, please list it below.

Submit

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