Vision Zero Study - Initial Survey
Thank you very much for your interest in this study!
This survey will help us collect some information to see if you are eligible to participate.

Before you fill out this form, please read the following notes:

What will take place in the session:
During a 1-hour one-on-one interview, we'll ask you some questions about your experiences traveling around the city.

For participating in the study you will receive $30 (gift card to your store of choice).

Privacy and confidentiality:
We will record audio and/or video/images from the interview. Any records from this study (notes and recordings) will be kept private. Only team members who require your original records will have access. We'll ask for your permission before anything public-facing is produced with your data (reports, papers, presentations, etc.).

If you have any questions, please contact Emily Dela Cruz at or XXX-XXX-XXXX.

Thank you for your time and consideration – we will be in contact if you are chosen to be interviewed.
Email address *
Full Name *
Address/Place of residence *
What year did you come to Canada? *
Do you take walks in the city at least 3 times a week? (For example: to go grocery shopping, for exercise, for fun, to go to work, to go to class) *
Phone number
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