Investigator: Laura Glowacki
You are being asked to participate in a research project conducted by a student in the Social Work Department at Western Illinois University. Please
read the information below and ask questions about anything you don’t understand before deciding whether or not to take part in the questionnaire.
This research questionnaire will explore attitudes of women with physical disabilities about their body esteem. Subjects who choose to participate should
be female and aged eighteen years or older who have a physical disability. The researcher respectfully requests that anyone not meeting those criteria
refrain from continuing to answer the survey. The questionnaire should take no more than 10-20 minutes to complete. The information gained
from the submitted questionnaires will be used to help students in the research class learn about the research process and about opinions on this topic.
You will also be asked several questions about yourself, including your age, gender, race, and disability in order to better understand characteristics of the
individuals who respond to the questionnaire. The answers to this questionnaire are anonymous. You will not be asked any questions that will reveal your
identity to the researcher. Please do not include your name anywhere on the questionnaire.
If you are willing to participate, please click on the link at the bottom of the page to continue on to the questionnaire. If you do not wish to participate,
you may simply close this window. Once you have viewed each page and reach the end of the questionnaire, please click the finish button in order to
submit your answers. By submitting your answers, you are showing your agreement to participate in the study. Participation in this study is voluntary.
You may choose not to respond to the questionnaire, or to answer only some of the questions. You may decide to stop answering the questionnaire at
any time. If you decide to stop the questionnaire, you may close out the browser window at any time before clicking the finish button. Note that after
clicking the finish button, you will not be able to go back in order to change your answers and/or withdraw from the study.
This survey contains questions of a sensitive nature which may cause some discomfort for some participants; however, the risk is minimal. Nevertheless, if
you feel you have not been treated according to the descriptions in this letter, you may contact the Institutional Review Board for the Protection of Human
Subjects at (309) 298-1191.
Should you wish to contact the researcher, you may email me at LJ-Glowacki@wiu.edu. You may also contact my course instructor:
Horrabin Hall 8F, 1 University Circle
Western Illinois University
Macomb, IL 61455
Thank you for your assistance.
To participate in this online survey, please click on the link below:
This information has been X-posted to the following communities: spina_bifida, weknowdisabled, cerebral_palsy, all_disability, musc_dystrophy,
ever_perceived, no_pity, and gimpgirl.