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

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Required format:

YKNpeKarzvn3qBrNtnIhdU3nNcHJ7ocMdPyqtyodG8btBiv

School Readiness Study

Thank you for your interest in the School Readiness Study!

Some groups have historically been underrepresented in research, meaning that some scientific findings may not apply to the entire community. It is very important to us to achieve a sample that includes groups who have been historically underrepresented in research so that the entire community benefits from our findings. To accomplish this, we ask the questions below to ensure our participants represent the range of diversity present in the greater Iowa City area.

If you have multiple children, please provide information for the child you would like to enroll in the study. In order to be eligible for the study, the child must be younger than 5 years and 4 months of age.

We will be in touch shortly!

Your Name:

* must provide value

Preferred Phone Number:

* must provide value

Preferred Email:

* must provide value

What is your child's date of birth?

* must provide value

M-D-Y

What is the sex of your child?

* must provide value

female

male

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What is your child's race? (select one or more)

* must provide value

American Indian or Alaska native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Other (please specify)

What is your child's race? (please specify):

* must provide value

Is your child Hispanic or Latino?

* must provide value

Yes

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What is the highest level of education you have completed?

No schooling completed, or less than 1 year

Nursery, kindergarten, and elementary (grades 1-8)

High school (grades 9-12, no degree)

High school graduate (or equivalent)

Some college (1-4 years, no degree)

Associate's degree (including occupational or academic degrees)

Bachelor's degree (BA, BS, AB, etc.)

Master's degree (MA, MS, MENG, MSW, etc.)

Professional school degree (MD, DDC, JD, etc.)

Doctorate degree (PhD, EdD, etc.)

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Please Clarify:

Some college credit but less than 1 year

One or more years of college at a 2-year program, no degree

One year of college at a 4-year program, no degree

Two years of college at a 4-year program, no degree

Three years or more of college at a 4-year program, no degree

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Do you have a parenting partner? (e.g., a spouse, a partner, another parent, etc.)

* must provide value

Yes

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What is the highest level of education your parenting partner has completed?

* must provide value

No schooling completed, or less than 1 year

Nursery, kindergarten, and elementary (grades 1-8)

High school (grades 9-12, no degree)

High school graduate (or equivalent)

Some college (1-4 years, no degree)

Associate's degree (including occupational or academic degrees)

Bachelor's degree (BA, BS, AB, etc.)

Master's degree (MA, MS, MENG, MSW, etc.)

Professional school degree (MD, DDC, JD, etc.)

Doctorate degree (PhD, EdD, etc.)

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Please Clarify:

* must provide value

Some college credit but less than 1 year

One or more years of college at a 2-year program, no degree

One year of college at a 4-year program, no degree

Two years of college at a 4-year program, no degree

Three years or more of college at a 4-year program, no degree

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How did you hear about us?

* must provide value

I was sent an email

Mass Email through the University of Iowa

School/preschool

Daycare center

Farmer's market

A community Flyer

Word of mouth

Facebook

Other (please specify)

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Please Specify:

* must provide value

Date Last Contacted To Screen:

M-D-Y

Contact Notes:

Expand

Has the Prospective Participant been scheduled for a screening call?

Yes

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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.