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2016
April
H
Halima Musse
Halima Musse
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Hello:
You are invited to participate in our survey Drugs and Alcohol: The effect on family relationships. In this survey, approximately 30 people will be asked to complete a survey that asks questions specifically about the effect parental substance misuse has on children’s development. It will take approximately 5 minutes to complete the questionnaire.
Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point, or if at any time you feel uncomfortable in answering specific questions you may choose to leave any question blank. It is very important for us to learn your opinions.
Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. You will be asked for your name and contact information but please rest assured that this is only for verification purposes and all your responses will be kept strictly confidential. In addition, identifying information will be separate from personal survey responses and only my instructor Emmy Manitaros and myself will have access to the list of participants and their contact information.
Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Halima Musse at 416-749-5164 or by email at
[email protected]
Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
Please identify your gender
Male
Female
Other
In what year were you born?
1998
1999
2000
2001
2002
What is your ethnicity?
Caucasian
African-Canadian
Asian
Hispanic
Other
What is the marital status of your parent/guardian?
Single, never married
Married
Widowed
Divorced
Separated
What is the highest degree or level of school you have completed?
No schooling completed
Kindergarten to 8th grade
Some high school, no diploma
High school graduate, diploma or equivalent
Other
Does you parent/guardian abuse drugs and/or alcohol?
Yes
No
Do you feel you receive motivation/ support from your parent/guardian?
Yes
No
What is your current average in school?
50-60
60-70
70-80
80-90
90+
Please tell me to what extent you agree or disagree with the following statement: If your parent or guardian abuses drugs/alcohol do you feel this has an effect on a child's academic performance?
Strongly Agree
Somewhat Agree
Somewhat Disagree
Strongly Disagree
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