Caregiver Relief Project Interest Form

Caregiver Relief Project Interest Form

Thank you for your interest in our Caregiver Relief project. This initiative encompasses a photo assignment and an interview series, which involves two meetings (one introductory session and one interview). These activities will enable us to gain deeper insights into the unique experiences, including the challenges and needs, encountered by caregivers from ethnic minority backgrounds. We kindly request that you fill out this form to show your interest in participation. Please note, participants must be a Canadian resident. You will be contacted very shortly, thank you!
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Age*
Are you an informal (not paid) caregiver of ethnic minority background caring for an individual with ABI (acquired brain injury - includes traumatic brain injuries, strokes, ischemia, etc.)?*

YesNo
Are you able to take photographs from your own device for the photo-elicitation portion of the project?*

YesNo
Are able to participate in two 60 minute verbal interviews in English via over the phone or Zoom? You are able to provide your own interpreter if needed.*

YesNo
How did you hear about our project?*
Please verify that you are human*
Should be Empty: