Dietary Restrictions Survey

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The purpose of this project is to investigate the possible social impacts on the daily lives of high school students due to dietary restrictions.

If you choose to participate you will be asked to fill out a brief questionnaire that will take about 20 minutes.

***This study is for 14-18 year old adolescents who are currently in high school or recently graduated within the past year. Participants must also have AT LEAST ONE of the following dietary restrictions:***
-Gluten-free
-Lactose/dairy-free
-Vegetarian/meat-free
-Peanut/tree nut free

If you do not have at least one of the four dietary restrictions listed above, thank you for your time but we will not be needing your participation.

Parental consent is required for all participants within 14-17 years of age. Consent to participate must also be given for all participants.

Confidentiality will be maintained throughout the survey because identity will never be asked. Additionally only basic questions about oneself that are crucial to understanding the results will be asked that cannot lead to identifying any one person. The benefits of this study are that the results may help those who have dietary restrictions better understand the impacts that their diets have on their every day life, and help them find the support they need to lead a fulfilling life.

There is always the possibility of tampering from an outside source when using the internet for colleting information. While the confidentiality of your responses will be protected once the data is downloaded from the internet, there is always a possibility of hacking or other security breaches that could threaten the confidentiality of your responses. Please know that you are free to decide not to answer any question

If you have any questions or concerns about this study, feel free to contact Michael Blueglass at mblueglass@yorktown.org

If you would like to know the results of this survey, which will be available in early 2015, feel free to contact dietaryrestrictionssurvey@aol.com, and title the email "Dietary Restrictions Survey Results Please".

Thank you for taking the time to complete this survey.
Jordan Tessler and Elisabeth Weir
Yorktown High School, NY

For those participants who are 14-17 years of age, parental consent is required. Please have a parent or guardian give their consent by checking the first box below. By doing so they are giving their consent for you to participate in this short survey. *

I am a parent/guardian and I give my consent

I am a parent/guardian and I DO NOT give my consent

I am 18 and give my consent to participate

Participation in this study is completely voluntary. If you decide not to participate there will not be any negative consequences. Please be aware that if you decide to participate, you may stop at any time and you may decide not to answer any specific question. By checking the box below you agree that you have read and understand the information above and give your consent to participate. *

I agree

I disagree

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