6.1 Consent Form
Survey of Participants in the Social and Economic Inclusion Initiative
The purpose of this research is to measure the process of social and economic inclusion in five Ontario communities.
Social and economic inclusion is both a goal and a process. It welcomes individual and groups who have been left out into the planning, decision-making and policy-development processes in their community. And it empowers them by offering the opportunities, resources, and supports they need to participate.
This survey is intended to help us gather information for our research. All surveys will remain anonymous and by giving your consent to fill out this questionnaire, you allow us to further our understanding of this concept. We would like to remind you that all answers are confidential.
Consent
I consent to filling out this questionnaire. I understand that only the researchers of the Social Planning Council of Cambridge (519-623-1713) and those working directly for the organization in this project will see the detailed answers to the questions. I understand my answers are CONFIDENTIAL and the questionnaires will be kept in a safe and secure place.
| ________________________ | _________________________ |
| Please print your name | Signature and Date |
Thank you for agreeing to fill out this questionnaire.
Please Send to:
Social Planning Council
24 Queen’s Square,
Cambridge, Ontario
N1S 1H6