Communication Neural Systems Research Group(Patrick C. M. Wong, Ph.D., Principal Investigator)
The Roxelyn and Richard Pepper Department of
   Communication Sciences and Disorders

School of Communication
Northwestern University
Home Projects Publications Media People Participate MRI Jobs Links

Speech Research Lab Questionnaire

Thank you for your interest in our research! To participate in our studies please fill out the questions below. This first page will ask for basic demographic and contact information. Once you hit "Submit and continue" you will be directed to a page with more specific questions. Please try to answer as much as possible. We will review your responses and contact you when a participant slot becomes available. If you have any questions or concerns please feel free to contact us by calling 847-491-2430, or by emailing hearingbrain@northwestern.edu.

1. Full name (Last, First): *required

2. Age:

3. Gender:

4. Contact (Email and/or Telephone #): *required

5. Place of birth (City, State, Country):

6. Please indicate handedness:

8. Are you responding because you have difficulty listening in noisy situations such as a crowded restaurant (more so than other people around you)? *required

9. How did you hear about our study?