Improving Lives Through Research®

Apply/Register to Join Future Studies

Westat maintains a database of people who would like to participate in testing new survey questions and other study materials for future research projects. If you would like to be a part of our research participant database, please complete the form below. To learn more, read the FAQs about Volunteering for Research Studies.

All information you provide will remain confidential. We will not share your name or any other information with any individual or organization that's not directly connected to Westat. For more information, see Westat's Privacy Policy.

If you do not want to be part of our general database, you may sign up to test materials for a current study only.


Participant Registration

    
    
 
(e.g., 111-222-3333)  
 
(e.g., 111-222-3333)  
 
 
   
 
 
 
 
(yyyy)  
Gender:  




Are you of Hispanic origin?  


What is your race? (check all that apply)  
What is the highest level of education you have completed?  
(e.g., 9, 11)  
How many people 18 or older live in your household, including yourself?  





Are there any children under the age of 18 in your household?  


Do you currently work for pay or profit?  


Do you work full-time or part-time?  


What is the main reason you are not currently working for pay or profit? Are you…  
Have you ever served on active duty in the U.S. Armed Forces, Reserves, or National Guard?  
Are you currently covered by Medicaid?  


Are you currently covered by Medicare?  


Has a doctor, nurse, or other health professional ever told you that you had any of the following medical conditions? Check all that apply.  
Has a doctor, nurse, or other health professional ever told you that you had cancer?  


What kind of cancer were you told that you had? Check all that apply.  
Are you deaf or do you have serious difficulty hearing?  


Are you blind or do you have serious difficulty seeing, even when wearing glasses?  


Do you currently smoke or use other tobacco products?  


Do you currently use e-cigarettes or other electronic tobacco products?  


What language do you usually speak at home?  







 

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