The code block below illustrates how one might use # and // as comments in your logic and calculations.

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The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

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This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

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Required format:

4QGqgKYFhgcLW9c6chaU6bJLXL78mmUhSeVnQIEJvxFVuIKwAVS6RxJ3hAR9ID3okuX4zexChspZhR67vPQFNDoPdSRkngGbfr6Z2UfwVx

Research Screening Survey

Thank you for your interest in joining research projects led by the Brain, Education, and Mind (BEAM Team), a lab led by Dr. Joanna Christodoulou at the MGH Institute of Health Professions!

We invite you to fill out the questionnaire below to determine eligibility for current or future studies. The information collected will be kept confidential. If you have further questions, you can contact us at beamstudies@gmail.com.

Thank you!

Name of Parent

* must provide value

Best phone number to contact you

* must provide value

Please share any days and times that you would like us to contact you.

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Email Address

* must provide value

Name of Child

* must provide value

Child's Date of Birth

* must provide value

D-M-Y

Gender

* must provide value

What grade will your child be in during the current school year?

Is your child predominantly right or left handed?

* must provide value

Right

Left

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Does your child have any metal in his or her body? If so, please specify (e.g., braces, permanent retainer, pacemaker, implants, or pumps).

* must provide value

Was your child born full-term or premature? If premature, by how many weeks?

* must provide value

Is your child a native English speaker?

* must provide value

At what age was your child first exposed to English?

* must provide value

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If your child speaks any other languages, which languages and at what age were they first exposed?

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Does your child speak English at home?

* must provide value

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Has your child ever had any medical diagnoses (e.g., depression, anxiety, ADHD, schizophrenia, or autism spectrum disorder)?

* must provide value

Yes

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If yes, please specify the medical diagnoses (e.g., depression, anxiety, ADHD, schizophrenia, or autism spectrum disorder).

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Does your child have a family history (including siblings or parents) of medical diagnoses (such as depression, anxiety, ADHD, schizophrenia, or autism spectrum disorders)?

* must provide value

Yes

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If yes, please specify the medical diagnoses (e.g., depression, anxiety, ADHD, schizophrenia, or autism spectrum disorder).

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Does your child currently take any medications? If so, which medications and for what?

* must provide value

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Does your child have any reading disability/disorder (such as dyslexia) or language impairment? If yes, please specify.

* must provide value

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Does your child have a family history (siblings or parents) of dyslexia or reading or language impairments?

* must provide value

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Does your child carry a diagnosis of math disability or dyscalculia?

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Does your child have a family history (siblings or parents) of math disability or dyscalculia?

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Is there any other information about your child that you think might be relevant to this study?

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Are you completing this survey for the SUMMIT Study (2019 summer academic programming)?

Yes

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I understand that the SUMMIT summer academic program requires attendance on weekday mornings (Monday to Friday) from July 8th to August 16th, 2019 and I would like my child to be considered for this program.

* must provide value

Yes

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Unlike typical academic summer camps, the academic programming through the SUMMIT study is meant to help us better understand how children respond to either reading or math instruction. We therefore are randomly assigning children to either type of instruction.

I understand that the assignment of my child to either reading or math instruction is random, and I would like my child to be considered for this program.

* must provide value

Yes

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Where did you hear about our studies?

* must provide value

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.