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 teenagers between 11 and 17 years old and their mothers. In order to participate, your mother must also agree to participate by completing a mother survey. You and your mother 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, your parent/legal guardian must read and sign the parent permission form and you must sign the agreement form below.

Parent Permission

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 give permission for my child to participate. I understand that this study is completely voluntary and any personal information gathered in this study will be kept private and confidential. I understand that my child and I can ask any questions that we 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.

Parent/guardian: Please type your full name here to give permission for your child to participate. (Your signature will be kept separate from the information your child provides on the survey below).

My Agreement

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 willingly agree to participate. I understand that taking this survey is up to me and it is okay if I change my mind and want to stop; my decision will not affect my standing at school or elsewhere. I understand that the any personal information I type in this survey will be kept private. I understand that I can ask any questions that I 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. 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.

Teen: please type your name here to indicate that you agree to participate (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.