Study title: Functional Imaging Studies of Visual Cortical Representation in Healthy Adults

Study number: IRB-AAAR7352

Principal Investigator: Nikolaus Kriegeskorte, PhD

Phone Number: (212) 854-3608

We are asking you to take part in a research study. We are doing this research study to learn more about how the brain processes visual information.

Prior to enrollment in this research study, we will need to ask you a few questions to confirm that you are eligible to participate. This will take approximately 5 minutes of your time. You will sign a separate consent form if you are found to be eligible to participate after completing this screening survey and choose to participate in the study.

There is no direct benefit to completing this screening survey and the only potential risk could be that your information is accidentally misplaced or accessed by someone who does not have the permission to access this information. We will protect your data by password-protecting the file and computer systems on which any data is stored. These computer systems will only be accessible by research personnel. Any information about you that is collected from this screening survey will be kept completely separate from information collected during the study. If you are found to be ineligible, the data collected will be destroyed.

The study team, authorities from Columbia University and NewYork-Presbyterian Hospital, including the Institutional Review Board ('IRB'), and the Federal Office of Human Research Protections ('OHRP') will be able to look at, copy, use and share your research information.

Participation in this screening survey is entirely voluntary. You are free to end participation at any time with no penalty.
You may call Nikolaus Kriegeskorte, PhD, at telephone # (212) 854-3608 if you have any questions or concerns about this research study. If you have any questions about your rights as a research subject, you should contact the Columbia University Medical Center Institutional Review Board by phone at (212) 305-5883 or by email at irboffice@columbia.edu.

The research study has been explained to me.  I agree to be in the research study described above. A copy of this information sheet will be provided to me. By agreeing to participate, I have not given up any of the legal rights that I would have if I were not a participant in the study.