Project PEAK/CAP Interest Form

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Please fill out the following form to express interest in Project PEAK or Project CAP. After completing the form, a project team member will contact you soon to provide additional information, answer any questions, and begin the eligibility determination process.

Your First and Last Name: *

Your Email Address: *

Your Phone Number: *

Preferred method of contact: *

Phone

Best days/times to reach you: *

Morning (8:00 AM - 12:00 PM)

Afternoon (12:00 PM - 5:00 PM)

Evening (5:00 PM - 8:00 PM)

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Which study are you interested in participating in? *

Project PEAK (Behavioral parent training program for caregivers of children who are ages 3-5 and showing high levels of inattention and/or hyperactivity)

Project CAP (Assessments for families and children who are ages 3-5 and not at-risk for ADHD, autism spectrum disorder, and/or other behavioral/emotional difficulties)

I am unsure and would like to learn more from a research team member

How old is your child?

2 years 0 months - 2 years 11 months

3 years 0 months - 3 years 11 months

4 years 0 months - 4 years 11 months

5 years 0 months - 5 years 11 months

Clear selection

Additional information you would like to provide or questions you have for the project team:

Submit

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