FVSU-GVRA Counselor Survey Consent Form

By clicking continue and completing the following survey, I understand that I have been asked to participate in a feedback survey which requires me to anonymously answer questions about my thoughts and perceptions related to how I feel at work, the inclusion of spirituality in practice and components of my overall life expectancies. Demographic information will also be collected.  This survey is being conducted in collaboration with the Georgia Vocational Rehabilitation Agency.  The goal of the results of this survey will be to enhance counselor well-being and professional practice through workshops and seminars.  It is understood that my identity will be protected with regards to my participation and that no identifiers will be asked for and I will never be identified by name or any manner such that my responses can be traced back to me. There is no for-seeable, undue risk on my part. I understand that my participation in this survey is voluntary and I can withdraw from participation at any time without fear of retaliation or penalty. If I wish to ask any questions regarding this survey I may do so by contacting Dr. Jerry Brenner at 478-825-6656/478-396-6275 or at brennerj@fvsu.edu.

Research involving Human Subjects at the Fort Valley State University is carried out under the oversight of the Institutional Human Subjects Committee. The Human Subjects Committee reports to the Provost and Vice President for Academic Affairs.

Contact information are as follows:
Dr. Ramon Stuart, Provost and Vice President for Academic Affairs
Phone: (478) 825-6330; E-mail:stuartt@fvsu.edu

Dr. Clarence E. Riley, Jr. (Chair, Human Subjects Committee)
Phone: (478) 825-6898; E-mail: rileyc@fvsu.edu

Fort Valley State University is accredited by the Commission on Colleges of the Southern Association of Colleges and Schools to award baccalaureate and master’s degrees. Contact Commission on Colleges at 1866 Southern Lane, Decatur, Georgia 30033-4097 of Call 404-679-4500 for questions about the accreditation of Fort Valley State University.

Fort Valley State University is an affirmative action, equal opportunity institution and does not discriminate against applicants, students, or employees on the basis of race gender, ethnicity, national origin, sexual orientation, religion, age, disability, marital or veteran status.