Thank you very much for choosing to participate in this survey of family life across families in Illinois and New York, USA and Kingston, Jamaica. This study is for mothers and their teenagers between 11 and 17 years old. In order to participate, you must also give permission for your teenager to complete a teen survey. Please note that only one parent-teen pair from each family is eligible to participate. You and your teenager will each receive a $10 gift card (U.S.) or a cell phone Top Up of similar value (Jamaica) after both surveys are submitted. Before you begin, please read and sign the consent form below.

Consent to Participate

I have read and understood the information on the study web page explaining the purpose and potential risks and benefits of this study and I hereby agree to participate. I understand that any personal information gathered in the study will be held in strictest confidence. This study is conducted in accordance with the guidelines for human research established by Knox College, the University of the West Indies and the American Psychological Association. I understand that I can ask questions I may have about the study at any time by contacting the principal investigator, Professor Gail M. Ferguson, or an independent advisor using the contact information provided on the study web page.

Please type your full name here to indicate your agreement. (Your signature will be kept separate from the information you provide on the survey below).

What is today's date? (mm/dd/yy)  

You will receive a confirmation email after submitting your survey.
Please enter your email address here (your email address needs to be unique to you, meaning that your friends or family members do not use the same email address):


Where did you hear about the Culture and Family Life Study?

After signing and dating this page, you may print a copy for your records if desired.
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The contents of this survey are copyrighted.