Thank you for signing up for future participation in our hearing research study.  Your name and contact information is being archived because you might be of great help in developing a diagnostic tool to assess the impact of hearing deficits, neurological impairments or brain injury on hearing or vision.

Signing up for this does NOT constitute any binding agreement of any sort on your part.  You are free to decline participation in the study at any time.  You are also free to request that your name be removed from the contact list.  If you ask to have your name removed, we will immediately delete your name from the contact list.  You are also free to decide, when contacted, that you do not want to participate in the study at that time.  This contact list will have only three electronic copies (one each with Prof. Terry Takahashi and Dr. Avinash Singh, and one copy as a backup on a CD).  No one other than the two named researchers is allowed access to this list.  The backup CD is stored in a locked closet, and accessible only to Prof. Takahashi.

            Your name and address will not be disclosed to anyone else.  This information is regarded as privileged, and is restricted to the two researchers named above.  Disclosure anyone else, including University administration and Government authorities, is not permitted.

            Your participation may not lead to any direct benefits to you, but will help us in devising a technique that may help other people with brain injury, neurological impairments, or hearing impairments.  For each session that you participate in, you will receive $7, as long as the session finishes in one hour or less.  For every additional hour or fraction of hour, you will receive an additional $7.  So you can rich while helping push the frontiers of science!

You do not need to fill it out completely, and can just give us your preferred contact information):

• Name
  (we need at least your last name+initials)
• Street Address
  
• City
• State
• Phone
• Other Phone
• Email
• Gender
• Year of birth

            If you have any questions, please feel free to contact Terry Takahashi, Professor of Biology: terry@uoregon.edu; (541) 346-4544.  For questions regarding your rights as a research subject, contact the Office for Protection of Human Subjects, University of Oregon, Eugene, OR 97403, (541) 346-2510.

PDF version of this document to print and fill out.

Check and see if you qualify to participate?
Further details and the consent form
Go back to announcement

Prof. Terry Takahashi. email Terry.
Dr. Avinash Singh. email Avinash
University of Oregon