NYC Technology Study Survey

Study Information

We have a technology study taking place in Chelsea (Manhattan) from 9/10 to the end of September. Times are 7:30am -8:30pm Daily. We are looking for kids UNDER the age of 18 to participate with their siblings. If siblings are not available, we can consider one child, but multiple siblings from the same family are preferable.

Session lengths for 5-13 year olds are no more than 45-60 minutes each and session lengths for 14-17 year olds are no more than 75-90 minutes each. We will get people out as quickly as we can to try to reduce those times.

Siblings can participate consecutively right after each other for maximum efficiency OR the parent can bring them in at different times and have multiple trips to the facility. Whateve works best for the familys schedule.

Parents get $100 PER child that participates. So if you have 3 children participate, the parent gets $300 Plus the children get:

· 5-9 year old children will receive a toy or game worth $20-$40

· 10-13 year old children will receive a Visa gift card worth $45 (other gift card options may be available)

· 14-17 year old children will receive a Visa gift card worth $65 (other gift card options may be available)

1.Contact Info(Required.)

Full Name:

Email:

Phone:

Age:

Gender:

City, State:

DOB:

2.Are you proficient in written and spoken english?(Required.)

Yes

3.Do you have normal or corrected-to-normal vision and hearing?(Required.)

Yes

4.Do you have full use of both hands and feet?(Required.)

Yes

5.Are you available to travel to Chelsea NYC between the hours of 7:30 AM and 8:30 PM to participate?(Required.)

Yes

7.What is your:(Required.)

Job Title:

Company:

8.Do you have a history of any serious medical condition that may hinder your participation in this study?(Required.)

Yes

11.Do you have any children under the age of 18 that can participate in the study?(Required.)

Yes

12.If yes, what are their genders/ages?

Child 1

Child 2

Child 3

Child 4

Child 5