Tinkering & Storytelling Participant Interest Form

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Thank you for your interest in our Tinkering & Storytelling research project, conducted by Loyola University in partnership with Northwestern University and the Chicago Children's Museum! Please complete this form thoroughly, and one of our staff members will be in touch shortly.

First & Last Name (Parent) / Nombre y Apellido (Padre) *

First & Last Name (Children) / Nombre y Apellido (Niño/a) *

Children's Ages / Edad del Niño(a) *

Preferred Method of Initial Contact / Metodo Preferido de Contacto Initial *

Email / Correo electrónico

Phone / Teléfono

Phone Number / Número de Teléfono

E-mail Address / Correo Electrónico

Preferred Date & Time for Contact / Fecha y Hora Preferida para Contacto (Central Standard Time) *

Are you and/or your child of Latino/Latine heritage (i.e., a person of Latin American origin or descent)? / Se considera usted y/o su hijo(a) venir de origines Latinos/Latine? *

Yes / Si

No / No

What is your preferred language? / Cual es su lenguage preferido? *

English / Ingles

Spanish / Español

How did you hear about the study? If you heard about it from a specific researcher, please provide their name.

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