CONSENT FORM

Orientation Feedback Survey

  “Toward Positive Change to Promote Mental Health and Wellbeing for Black Canadians in Manitoba” 

Thank you for taking time to complete the survey. Your feedback is very important. Please note that completing this survey is voluntary. The results of the survey will be collated and reported in aggregate to assess the extent to which mental health promotion for Black Canadians Toolkit is effective in promoting mental health for Black Canadians. Please be assured that all information collected in this survey is strictly confidential. The survey takes approximately 5 to 10 minutes to complete.

Please complete the following questions: