PARTICIPATION AND CONTACT INFORMATION

PARTICIPATE IN OUR RESEARCH

If you are the parent of a child (or children) 13 years old or younger, the Developmental Cognitive Neuroscience Lab would like to invite your family to participate in our child development studies. It's a fun and easy way to contribute to research and science.

Our research studies in the past have included behavioral testing, MRI, and EEG.  

For more information about our current research studies, please sign up below or contact us at dcn@northwestern.edu or 847-467-6842.

Parent Information
Name*:
ZIP Code:
Home Phone:	( ) -
Cell Phone:	( ) -
E-mail*:
Where did you hear about the Developmental Cognitive Neuroscience Lab?
Language Information
Are there non-English languages spoken in your home?	No   Yes
If yes, what language(s):
How much?	less than 10% 25% 50% (bilingual) 75% 100% (no English spoken at home)
Child #1
Name:	Select Gender Boy Girl
Birth Date:	/ /
Full Term (born after at least 37 weeks of gestation):	No   Yes
Handedness:	Not yet known Right Left Ambidextrous
Child #2
Name:	Select Gender Boy Girl
Birth Date:	/ /
Full Term (born after at least 37 weeks of gestation):	No   Yes
Handedness:	Not yet known Right Left Ambidextrous
Child #3
Name:	Select Gender Boy Girl
Birth Date:	/ /
Full Term (born after at least 37 weeks of gestation):	No   Yes
Handedness:	Not yet known Right Left Ambidextrous
Child #4
Name:	Select Gender Boy Girl
Birth Date:	/ /
Full Term (born after at least 37 weeks of gestation):	No   Yes
Handedness:	Not yet known Right Left Ambidextrous
Future Contact
Would you like for us to share your information with other N.U. labs studying learning and child development? Yes No

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