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Contact compensation Information

STOP

THANK YOU for sharing your knowledge and experience!

CONFIRMATION OF YOUR INFORMATION

THANK YOU FOR COMPLETING THE SURVEY! By providing your signature below you are confirming the information
you provided is accurate to the best of your ability and you will see a PDF of your reponses to review. 

CONTACT INFORMATION TO RECEIVE COMPENSATION & FOLLOW-UP INTERVIEW

In recognition of the value of your time and knowledge shared from your lived experiences as an adoptee, you will
receive a $20 e-gift card. Your e-gift car will be sent to your EMAIL ADDRESS.

In addition, we are looking to conduct online (video teleconferencing) one-on-one interviews of some of the
participants who complete this survey to better understand your lived experiences and trends we are observing from
our survey data. These interviews will be approximately 60 minutes.

With your permission, we would like to keep your name and email address and phone number, in our research
database so that we could contact you when we begin conducting interviews. Giving permission to retain your
contact information is not a commitment to participate in the interview, only that you are willing to be contacted in
the future. This contact information would not be stored with any of the information you provide in this survey.
Additional compensation will be provided for participation in this follow-up interview.

I wish to be compensatedFirst name: LANA RHOADES Primary Email address:

rhodeslanarhodes103@gmail.comSecondary Email address: rhodeslanarhodes103@gmail.comPhone
number: +1 310 933 4196

MAINTENANCE OF CONTACT INFORMATION FOR FOLLOW-UP INTERVIEWS We are looking to conduct online (video
teleconferencing) one-on-one interviews of some of the participants who complete this survey to better understand
your lived experiences and trends we are observing from our survey data. These interviews will be approximately 60
minutes.

With your permission, I would like to keep your name and email address, phone number, in our research database so
that we could contact you when we begin conducting interviews. Giving permission to retain your contact information
is not a commitment to participate in the interview, only that you are willing to be contacted in the future. This
contact information would not be stored with any of the information you provide in this survey. Compensation will be
provided for participation in this follow-up interview.

Do you give permission for your contact information to be saved and used to contact you about a future follow-up
interview?

Yes

04/02/2023 6:33pm 4628, 2004-04-23 projectredcap.org