Community Engagement Questionnaire

Posted March 13, 2013

Questionnaire CONSENT FORM

Researcher: Christine Nieder
Purpose: The purpose of this study is to investigate the relationship between early community engagement and skill sets obtained against the success of employment of blind, deafblind and partially sighted Canadians between the ages of 22-64.

You have been invited to participate in this study as a blind, deafblind or partially sighted individual between the ages of 22-64 living in Canada in relationship to your early community engagement experiences, skill sets gained, measured against your success in employment. As the researcher, I am interested in learning about the relationship between these factors and how early community engagement positively influences blind and partially sighted individuals in adulthood.

The findings of this project will be used in partial requirements for the completion of my Masters of Educational Leadership (Post-Secondary). The final report and results will be presented during the 2013 Summer Institute, other conferences, and publication opportunities. The results of this research is part of a pilot study that will be used to inform a larger study on the types of skill sets obtained and what relation they have to success in employment.

Study procedures

You are being invited to participate in this online questionnaire through This is a Canadian based survey tool. This specific medium allows for skip logic, full accessibility for speech users, and all data will be stored on Canadian servers. The data will be kept on a Canadian server and all information is anonymous and will be stored on an encrypted USB. At no time during this study will your personal identifiers be disclosed.

The survey is made up of demographics, early experiences in volunteering, participation in sports, and your experiences in employment.

The survey will take approximately twenty to twenty-five minutes to complete.

Risks to participant:.

There are minimal risks to you as a participant in this project.

The benefits of this study:

This survey will provide the opportunity to gain valuable insights into the role that community engagement; volunteerism and involvement in sports plays in employment success of blind and partially sighted Canadians. Your responses to this questionnaire will provide information as to the importance of the effects of community engagement plays in the relationship to success in employment and the skill sets that are most beneficial to blind, deafblind and partially sighted people in their work environment.


Participation in this questionnaire is entirely voluntary. You have the right to not answer any question and to withdraw from the questionnaire at any time. To withdraw from this survey, simply close the web browser and none of your answers will be saved.

Your choice to not participate in this study will have no negative impact on your relationship with the researcher.

All your responses will be held in strictest confidence. All responses will be summarized and presented in a way that ensures your confidentiality.

Your consent to participate in this project is assumed upon your choice to submit the survey.

All information gathered from the questionnaire will be coded and your confidentiality will be protected to the full extent permitted by law. The data will be kept in a locked office and password protected on a computer hard drive. Only I, Christine Nieder, and my faculty supervisor, Dr. Michelle Pidgeon, will have access to the data. Dr. Mahadeo Sukhai will also be granted access to the data after July 31st, 2013 for purposes of further analysis for future co-investigative projects.

Contact for information about the study:

You may obtain copies of the results of this study, upon its completion by contacting Christine Nieder.

If you have any questions about this project, please contact either Christine Nieder by email at or Dr. Michelle Pidgeon at 778-782-8609 or by e-mail

Contact for concerns about the study:

If you have any concerns about your rights or treatment as a research participant, please contact the contact the Office of Research Ethics, via e-mail or phone 778-782-6785.
Many thanks for your assistance,

Christine Nieder

To fill out the Survey go to