Objects for Everyday Resilience Consent Form
Consent and Submission Form
Name
*
Are you submitting an object?
*
Yes
No
Other
Are you at least 18 years of age?
*
Yes
No
Other
Please make sure your parent/guardian fills out
this form.
What is your age?
*
What is your cultural or ethnic background? (Optional)
What is your religious background? (Optional)
What was your annual income during the 2020-2021 financial year? (Optional)
$0 - $18,200
$18,201 – $45,000
$45,001 – $120,000
$120,001 – $180,000
$180,001 and over
How would you characterise your living circumstances during lockdown?
*
1.I was a primary caregiver (of child/ren, elderly parent(s), someone with a disability)
2. I lived alone
3. I was required to work outside (essential worker)
4. I kept my job
5. I lost my job or was unemployed
6. I lived in a comfortable home
7. I was confined to a tiny flat
8. I had access to digital technologies
9. I had limited access to digital technologies
How would you characterise your living circumstances during lockdown? # 2
*
1.I was a primary caregiver (of child/ren, elderly parent(s), someone with a disability)
2. I lived alone
3. I was required to work outside (essential worker)
4. I kept my job
5. I lost my job or was unemployed
6. I lived in a comfortable home
7. I was confined to a tiny flat
8. I had access to digital technologies
9. I had limited access to digital technologies
What is the object you are submitting?
*
What is your relationship to the object you are submitting?
*
How has the object supported you during the pandemic?
*
I consent to:
*
Participating in the Objects for Everyday Resilience Research Project through the submission of my object
A photo or sample of my object being part of the Objects for Everyday Resilience online Exhibition
My object being displayed as part of the in-person Exhibition
Other
I understand that by consenting to participate in this research project:
*
My object-related data may be displayed in a public exhibition if I so decide
My data will be securely stored and protected
I would like my data to remain anonymous
Any data I submit will be analysed in terms of its resilience-building capabilities
I can withdraw my data at any time but project findings may still reflect my submitted data
Other
Optional: Tell us a story about how your object helped you during lockdown. Please submit an audio and / or word file.
Browse Files
Drag and drop files here
Choose a file
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of
Would you like to be contacted about this study (ie. for a future interview)?
Please submit a photograph or a sample of your object here
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Email: please provide an email address so we can inform you of project-related updates and findings.
*
example@example.com
Please indicate whether you would like to go into a draw to win a $30 gift voucher (30 available).
Submit
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