Information and Consent Form

Please take the time to look at the Information and Consent Form explaining the objectives and conditions of the survey. If you have any questions, you may contact any of the Project Managers.
 
This project is funded by the Public Health Agency of Canada.

Instructions
This survey will only take 30 minutes to complete. Take time to answer each question as honestly as possible.

Objectives of the survey

La Coalition Sida des Sourds du Québec invites you to participate in a survey designed to learn how and where deaf and hard of hearing persons have received their sex education and knowledge about sexuality. We are also looking at whether the lack of communication accessibility to health services has an impact on sexual education and knowledge related to sexuality in the deaf community.

Advantages and risks of the survey
Basically, you will be helping La Coalition Sida des Sourds du Québec collect as much data as possible in order to research and arrive at a final result which will prove essential to the deaf community regarding their sexual education, knowledge and access to health services. The results will help us to find ways to improve our understanding of the sex education of deaf and hard of hearing persons. There are no risks associated with your participation in the survey. If you feel uncomfortable about answering some difficult questions, you are free to refuse to answer them.

Confidentiality
All your answers to the survey questions are strictly anonymous and confidential. Only project managers can access them. Your answers will be used solely in order to meet project objectives and formulate solutions.

Voluntary participation and right of withdrawal
You are free to accept or refuse to participate in this survey. Also, you can stop answering survey questions at any time, without giving us your reasons for doing so. Or if you wish, it is possible for you to refuse to answer certain questions without having to withdraw from the survey completely.

Consent
o I acknowledge that I have read the information and consent form.
o I understand the objectives of the survey.
o I know the benefits and risks of my participation in the survey.
o I am aware that my answers are confidential.
o I understand that I can withdraw from the survey if I wish to do so.




Project managers

Charles Gaucher, Ph.D.
Associate Professor at the School of Social Work
University of Moncton
Moncton (New-Brunswick)  E1A 3E9
Email: charles.gaucher@umoncton.ca
Tel.: 506-858-4172
Fax: 506-858-4508

Éric Dubé
Consultant and Project Manager
Coalition Sida des Sourds du Québec
Email: intervention@cssq.org
Skype and ooVoo: cssqintervention

Charline Savard
Project Assistant and Support Officer
Coalition Sida des Sourds du Québec
Email: assistantdeprojet@cssq.org
| ooVoo : soutien_cssq | Skype : cssqsoutien

If you have any ethical questions or concerns about this research, you can contact the Faculty of Graduate Studies Research (FESR), Université de Moncton.

* 1. My age is:

* 2. My gender identity is:

* 3. I express my sexuality: (Check as many as apply)

* 4. My religion is:

* 5. My regular partners are: (Check as many as apply)

* 6. The highest level of education I have completed is:




* 7. My occupation: (Check as many as apply)

* 8. I live in:

* 9. The first language I learned in childhood and can still understand is:

* 10. My understanding of written French is:

* 11. My understanding of written English is:

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