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Research Consent to Participate in a Study about Your Experience in Youth Programs

Research Consent to Participate in a Study about Your Experience in Youth Programs

If you ever participated in a youth program when you were in middle or high school—no matter if that was 2 years ago or 20 years ago—and you are 18 years or older, then you're invited to complete this survey! 

Study Info: The study, officially titled The Long-Term Outcomes of Youth Media Programs, is being conducted by the Social IMPACT Research Center, and we are trying to understand the impact that youth programs have on the people who participated in them. In particular, we are interested in what effect youth media programs have on people, but are also interested in other type of youth programs. 

You might recognize some of our study partners: Columbia Links, Community TV Network, Free Spirit Media, Strategic Human Services, Radio Arte, Street-Level Youth Media, True Star Foundation, We The People Media, and Young Chicago Authors. 

Risks and Benefits of Participating: By agreeing to participate in the study (which you will indicate by completing in the information below and checking the "Agree" box) and completing this survey your name will be entered into a random drawing for one of THREE Kindle Fires. 

You will be contributing by helping youth programs understand how effective they are and what they can do better to make a difference in the lives of the youth they work with. Your participation in this study is completely voluntary. You may choose not to participate. If you decide to participate in this research, you may withdraw at any time. If you decide not to participate in this study or if you withdraw from participating at any time, you will not be penalized. 

This study poses very little risk to you. We take confidentiality very seriously and will not share your responses with anyone—not even the youth organizations you were formerly involved with. We will take your responses and put them in with hundreds of other people’s responses to draw conclusions and write reports, in which we will never use your name or mention your participation. 

If you have any questions about the study, please contact Suniya Farooqui: 
• Email YouthMediaResearch@gmail.com 
• Call 1-855-831-4961 
• Text 1-872-228-7605 

This research has been approved by Heartland Alliance’s Research Review Committee ensuring it meets procedures for research involving human subjects.

ELECTRONIC CONSENT: Please select your choice below. Clicking on the "agree" button below indicates that:

  • you have read the above information 
  • you voluntarily agree to participate 
  • you are at least 18 years of age
If you do not wish to participate in the research study, please decline participation by clicking on the "disagree" button. *This question is required.