DramaQueenLucy
3-10-2007, 9:30 AM
If you are a mom with young children living with you full time we need you for a paid research study. Please send us your responses to the following questions; if you fit the criteria we will give you a call. Make sure you send your name & phone number.
Thanks for your continued interest.
1. Please record the age and gender of your children?
1st child’s age & gender _________________________
2nd child’s age & gender _________________________
3rd child’s age & gender _________________________
4th child’s age & gender _________________________
2. Your Age
3. Your Ethnic background
4. Do any of your children suffer from Night terrors?
Yes or No (which child?)
5. Do any of your children take medication for ADD or ADHD? Yes or No (which child?)
6. Do any of your children experience Bed Wetting? Yes or No (which child?)
7. Are any of your children being tested for Speech or Language therapy, Reading comprehension?
Yes or No (which child?)
8. Are you the legal parent of these children? yes
Please include your Name & phone number, best time to call you.
Name:
Phone Number:
Best time to call:
Thanks for your continued interest.
1. Please record the age and gender of your children?
1st child’s age & gender _________________________
2nd child’s age & gender _________________________
3rd child’s age & gender _________________________
4th child’s age & gender _________________________
2. Your Age
3. Your Ethnic background
4. Do any of your children suffer from Night terrors?
Yes or No (which child?)
5. Do any of your children take medication for ADD or ADHD? Yes or No (which child?)
6. Do any of your children experience Bed Wetting? Yes or No (which child?)
7. Are any of your children being tested for Speech or Language therapy, Reading comprehension?
Yes or No (which child?)
8. Are you the legal parent of these children? yes
Please include your Name & phone number, best time to call you.
Name:
Phone Number:
Best time to call: