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Volunteer Sign-up Form
National Center on Accessibility Research Studies

People with disabilities interested in participating in future NCA research studies can sign up at any time. Please complete the following information and return it to the National Center on Accessibility. Your information will be kept on file and you will be contacted when/if an NCA reasearch activity is conducted based on your areas of interest and geographic location.

Please Note: Fields marked with an asterisk are required

Terms of Use

Personal information provided by volunteers will be kept secure and strictly confidential by the National Center on Accessibility at Indiana University. NCA will contact volunteers directly with information on upcoming studies and opportunities for participation in research stuedies. Personal information will solely be used by NCA and/or a collaborative research partner(s). No portions of personal information will be shared or sold for comercial purposes. Volunteers will have the right to request removal from the research volunteer list at any time. Volunteers also have the right to decline participation in research studies at any time. To request to be removed from the research volunteer list, you can either call, e-mail, or fax NCA

Personal Information *

/ / (mm/dd/yyyy)

Sex (check one): *

Marital Status (check one): *

Highest Level of Education Completed (check one): *

Race/Ethnicity (check one) :

Type of Disability (check all that apply): *

Type of Disability/Condition/Diagnosis (check all that apply): *

Type of Assistive Device (check all that apply): *

Recreational Interests (check all that apply): *

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