Eligibility Survey for Reading Study

The Church Lab at the University of Texas at Austin is seeking 6th-8th grade volunteers for a reading neuroimaging study. Please complete the following survey to determine your child's eligiblity.

There is NO RADIATION involved in our studies. It is non-invasive and will require approximately 3-4 hours of your time on available weekends or weekday evenings. Your child will receive compensation for their participation in the study.

For more information, please visit http://labs.la.utexas.edu/church-lang/, call 512.471.2228 or email us at churchlab@austin.utexas.edu.

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There are multiple parts to the survey.

Part 1: The first part should take no more than 2-3 minutes.

Part 2: In order to determine eligibility, you will be required to submit personal health information. This part will take approximately 10 minutes.
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Hay varias partes de este cuestionario.

1: La primera parte deberia tardar aproximadamente 2-3 minutos.
2: Para determinar la elegibilidad de su hijo/hija, se le solicitara que envie su informacion de salud personal. Esta parte deberia tardar aproximadamente 10 minutos.

Please select which language in which you would like to complete this survey.
Seleccione el idioma en el que desea completar esta encuesta.

* must provide value

Notes

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Please enter the date you are completing the survey.

**CLICK THE "TODAY" BUTTON.**

* must provide value

M-D-Y

Your child's birth date (in mo-day-yr format)

* must provide value

M-D-Y

Our system will record your child's age, in years, as:

View equation

Gender

Female Male Non-Binary Other

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Please provide a brief explanation

Weight (lbs.):

Height:

What language(s) are spoken at home with your child?

Is your child a fluent English speaker?

* must provide value

Yes No

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Please select your child's grade level:

* must provide value

Please provide a brief explanation

* must provide value

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.