COPE • CARE • CONNECT

COPE • CARE • CONNECT

In Crisis?
About
Survival Guide Booklet

PLEDGE FORM

Fill in this Pledge Form to make your pledge official!

But before you do, please tell us: whether your answers can be included in a Brock study of CopeCareConnect.ca

I’m making a pledge; DO use my answers for the study

I’m making a pledge; DON’T use my answers for the study

My pledge is:

My email is:

I attend Brock University:

yes

no

About the Study

Click here for complete info about the study

Grade:

1^st year student

2^nd, 3^rd, 4^th or 5^th year student

Grad student

not a student

prefer not to answer

Age:

Gender:

Prefer not to answer

Female

Male

Another gender

In the past month, I…

drank alcohol

vaped/smoked

used cannabis

took prescribed medication for mental health concerns

Please add me to the CopeCareConnect email list to receive updates & invites 1-2 times/year.

Please submit your answers

COPE • CARE • CONNECT

Brock University
Niagara Region
1812 Sir Isaac Brock Way
St. Catharines, ON
L2S 3A1 Canada
+1 905-688-5550

Dr. Kelli-an Lawrance, Associate Professor
Department of Health Sciences
klawrance@brocku.ca