UVa fMRI Study Pre-Screening Form
This form is designed to help us determine your eligibility for this study. Note that all answers are confidential and will not be viewed by anyone outside outside of the study investigation team. 
* Required
What is your UVa ID? (if you do not have a UVa ID, please enter an acceptable email address instead) *
Have you ever previously had an MRI (for either medical or research purposes)? *
Yes
No
Do you have any history of a developmental or neurological disorder? *
Yes
No
Do you have any metal implants or devices? *
Yes
No
Do you have any history of shrapnel injury? *
Yes
No
Do you have any history of claustrophobia? *
Yes
No
Are you pregnant or trying to become pregnant? *
Yes
No
Have you ever had a concussion? *
Yes
No
Which option best describes your vision? *
Normal (without any correction)
Normal with contact lenses
Normal only with the use of glasses
Are you between 18 and 60 years of age? *
Yes
No
Are you right-handed? *
Yes
No
Is English your native language? *
Yes
No
Are you capable of reading and understanding code written in C? *
(basic understanding of syntax and structure is enough)
Yes
No
Please describe your current level of education/experience regarding computer programming. *
Please mention years studied, degrees earned, and any relevant work experience.
Please use this space to mention anything else you feel may be relevant in determining your eligibility for this study.