[checkbox checkbox-663 “I am interested in participating in research studies at GSU’s Psychology Department.”]
[checkbox checkbox-179 “I am interested in having my child participate in studies at GSU’s Psychology Department.”]
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City:	[text text-834 15/]	Zip:	[text text-815 5/]
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Comments: [textarea textarea-87 75×5]
Information about children (if applicable)
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[submit]

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