January 15, 2020

Gina Dennik-Champion, RN, MSN, MSHA

Executive Director of Wisconsin Nurses Association

Dear Gina Dennik-Champion,

I am a student of Masters of Art in Nursing from Our Lady of Fatima University, Metro Manila,
Philippines writing my thesis tentatively titled “Knowledge in Disaster and Emergency Care Management
among Nurses in Tertiary Government Hospitals in Quezon City”

I would like your permission to adapt the survey “Emergency Preparedness Information Questionnaire
(EPIQ)” instrument in my research study under the following conditions:

 I will use this survey only for my research study and will not sell or use it with any compensated
activities.
 I will include the copyright statement on all copies of the instrument.
 I will send my research study once it is completed.

If these are acceptable terms and conditions, please indicate so by returning it to though email.

Sincerely,

Jaqueline Kaye T. Kalaw, RN

MA Student

Expected date of completion July 2020