If you would like someone to fill this form out together with you, please call (514) 398 4400 – (09670) and leave a message with a phone number and the best time to contact you, and a research team member will call you back within 24 hours of receiving the message.
4. Please check all that apply. Do you self-identify as :
3. Do you self-identify as a person living with neurocognitive challenges?
4. Do you self-identify as caregiving for a person living with neurocognitive challenges?
5. Do you self-identify as indigenous?
5. Do you identify as a newcomer to Canada? (How long you and your family have been here)
7. Do you self-identify as having a disability?
8. Do you self-identify as being a part of the LGBTQ+ community?
6. We have been asked by the Public Health Agency of Canada to track the reach and impact of our initiative, can you please check as many as apply. I self-identify as,
7. In which What connects us-Ce qui nous lie Partner(s) activity and/or activities do you or will you participate? Please scroll down and check as many as apply:
8. Are you a volunteer or a student working with the What connects us~Ce qui nous lie project? If yes, please indicate your educational background.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Older adults are able to use technology to stay connected (e.g., computers, ipads, Skype, Zoom, etc…)
Older adults are not able to learn how to use technology to stay connected (e.g., computers, ipads, Skype, Zoom, etc…)
11. Check which of the following communication tools you have used in the past week:
12. The following are health questions related to quality of life:
a) In general, would you say that your health is:
 
How many days during this period, would you say your physical health was not good?
How many days during this period, would you say your mental health was not good?
How many days during this period, would you say you have difficulties performing your usual activities due to your physical or mental health?
Very Strongly Disagree
Strongly Disagree
Disagree
 _
Agree
Strongly Agree
Very Strongly Agree
14. Do you know anyone else who would like to participate in the what connects us~ ce qui nous lie project?
https://whatconnectsus-cequinouslie.org/
If you would like a record of your answers, please send us an email at info@whatconnectsus-cequinouslie.org with the title of your survey and date you completed it.

We thank you for your time and engagement with helping us build an interconnected community for persons living with Alzheimer's and/or other related disorders and their carers. 

If you would like to hear about other ways in which you can participate in research and help develop activities and become a member of What connects us - Ce qui nous lie please go to our website, https://whatconnectsus-cequinouslie.org

If you would like a list of mental health resources, please request for the Community Care Networks; Telehealth intervention to reduce isolation of older adults (TIP-OA) or Warm lines from the ‘’Little Brothers’’ Association.
If you attended Time, Family, and Conversations about Neurodiversity and would like a copy of the wooclap word cloud, please enter your email below.
Please enter your email or phone number here and a research team member will get back to you soon. 
Phone number:
If you would like to be contacted for any interviews, please send us an e-mail at: info@whatconnectsus-cequinouslie.org