Auditory Neuroscience Laboratory

Auditory Neuroscience Laboratory

Recruiting for IRB# STU16500, STU42658

I would like to receive more information

If you are between the ages of 18 and 65 and are interested in being a participant in our research studies, we invite you to fill out the form below. You will be compensated at least $10.00 per hour for participating. Sessions last 3 to 4 hours and we are happy to discuss arranging multiple sessions. We will be contacting you in a couple of days following receipt of the information you have provided. If you do not hear from us within one week, please do not hesitate to call the lab at 1-847-491-2457. ANY INFORMATION PROVIDED WILL BE KEPT CONFIDENTIAL.

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General Information
First Name and Last Initial*:
Age*:
Zip Code*:
Day Time phone (including area code):
Evening phone (including area code):
E-mail*:
Language Information
Are you a native English speaker?: No Yes
If you are not a native English speaker, at what age did you begin learning English?:
Do you speak any languages other than English?: No Yes
If yes, what language(s)?: Level of fluency on a scale of 1(novice) to 5(expert)? At what age did you begin speaking language?  
 
 
 
Musical Experience
Do you play any instruments? No Yes (If yes, please list the instrument (including vocals)):
Instrument 1:
Years of experience:
Years of consist practice:
Age began playing instrument:
Level of expertise for this instrument: Beginner Intermediate Advanced Professional
Instrument 2:
Years of experience:
Years of consist practice:
Age began playing instrument:  
Level of expertise for this instrument:: Beginner Intermediate Advanced Professional
Instrument 3:
Years of experience:
Years of consist practice:
Age began playing instrument:  
Level of expertise for this instrument: Beginner Intermediate Advanced Professional
 
Hearing Ability
Do you have any hearing loss? No Yes
If yes, please describe:
Please list all situations where you have difficulty with your hearing:
On the telephone: No Yes
In conversation with one person: No Yes
In a group: No Yes
In noisy situations: No Yes
When people talk to fast: No Yes
In large rooms/auditoriums: No Yes
Other (please specify):
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Thank you for signing up with us today and answering our questions. Please feel free to share our sign-up page and invite others to participate in our studies.