Thank you for participating in our survey!

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You are being asked to complete a digital survey to assess your professionalcancer survivorship work experience. This form has important information regarding the survey and how your contribution will be utilized. Please read over all sections thoroughly.
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Study Title: Evaluating Cancer Survivorship in California Tribal Communities
IRB Study Number: IRB Project 2019-009
Principal Investigator: Kathleen Jack, MPH Deputy Director of Research and Public Health
Program Evaluator: Eugene Kwon, MPH

Purpose
The California Rural Indian Health Board, Inc. (CRIHB) would like to evaluate the access to cancer survivorship resources in California Tribal communities. In order to assess this, the California Tribal Comprehensive Cancer Control Program (CTCCCP), a program housed within CRIHB is conducting a survey for healthcare providers. After conducting this evaluation, the CTCCCP plans to utilize this data to assist Tribal Health Programs in implementing comprehensive cancer survivorship related interventions throughout California Tribal communities.

Procedure
You are being asked to complete a survey and answer questions regarding your professional experience with cancer survivorship. This survey will take approximately 5 - 10 minutes.

Risk/Benefit
Answering interview questions will be of no risk to you. If you are uncomfortable answering any questions, you are free to skip to the next question or end your participation in the survey. This survey has been designed to maintain your privacy and your responses will have no identifiable connection with you.

Confidentiality
All information collected through this survey will be confidential. No personal identifying information will be collected from you. The survey submissions will be kept in a secure location, and only project staff will have access to the information. All staff with access to submissions have received training in protecting confidential information.

Your Rights as a Participant
Participation in the interview is voluntary. You may skip any questions you do not wish to answer. If you would like to obtain a copy of the survey questions or have any questions, please contact Eugene Kwon, the Program Evaluator, by calling 916-929-9761 or at Ekwon@crihb.org.

Question Title

* 1. Do you agree to these conditions?

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