Instructions:
To determine if your parent-teen pair is eligible to participate in this study, please complete the brief survey below. All of your responses will be kept confidential.
1. How old is your teen?
Please answer question 1.
2. How does your teen identify?
Male
Female
Nonbinary
Prefer to describe
Please answer question 2.
3. How does your teen describe their gender?
4. What grade is your teen in?
< Select a grade >
5
6
7
8
9
10
11
12
Please answer question 4.
5. Is your teen of Hispanic, Latino, or Spanish origin?
Yes
No
Please answer question 5.
6. What race is your teen?
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Multiracial
Other (Please describe)
Please enter the teen's race.
7. Has your teen ever been in a clinical trial or a research study after the age of 5?
Yes
No
Please answer question 7.
8. Does your teen have a chronic illness, disease, or disorder (for example: asthma, epilepsy, ADHD, etc.)?
Yes
No
Please answer question 8.
9. How old are you?
Please answer question 9.
10. How do you identify your gender?
Male
Female
Nonbinary
Prefer to describe
Please answer question 10.
11. How do you describe your gender?
12. Are you of Hispanic, Latino, or Spanish origin?
Yes
No
Please answer question 12.
13. What is your race?
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Multiracial
Other (Please describe)
Please enter your race.
14. Do you and your teen speak and read English fluently?
Yes
No
Please answer question 14.
15. Does your family have access to a computer or tablet that has Internet access?
Yes
No
Please answer question 15.
16. Does your family have a physical mailing address to receive the study gift cards (not a P.O. box)?
Yes
No
Please answer question 16.
17. Where did you hear about this study?
School
Social media
Friend/family member
Community organization
Other
Please answer question 17.