Qualtrics Survey | Qualtrics Experience Management

Thank you for your interest in research studies at the UC Merced Center for Early Cognition and Language. We are currently recruiting children between 1.5 and 7 years old. If you are interested in participating, please complete the form below and one of our staff will contact you. All information in this form will be kept strictly confidential.

If you would like more information about our research, you can also contact us as cecl@ucmerced.edu.

Your name

Your email address

Your phone number

Your child's first name

Your child's birthdate

Your child's birthdate
	Month	Day	Year



Please Select:	Month - Please Select:	Day - Please Select:	Year - Please Select:

Your child's sex

Male
Female

How would you like us to contact you?

Phone
Email

If you prefer to be contacted by phone, please tell us the best days and times to reach you.

Have you been to our center before?

No
Yes

Is there any additional information that you would like us to know? If you have additional children who could participate, you can tell us about them here.