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Section 1 of 2
Screener

Thank you for your interest in our study for CS247B - Designing for Behavior Change. This is a class at Stanford University in the Computer Science Department. 

The following is a brief questionnaire (< 2 - 3 minutes) to get a better sense of your academic, social, and extracurricular life. Your responses will solely be used to understand if you are a fit for the behaviors we are designing for and eligible to participate in our study. (Filling out this form in no way obligates you to participate in the study.)

This study will run from 1/22 - 1/26, requiring around 10 - 15 minutes of your day, and will hopefully help you discover more about your habits!

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First name
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Last name
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Are you a high school student?
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No
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What year are you in?
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9th
10th
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Where do you go to school? (School name, city)
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Are you happy with your ability to focus or would you like to be more focused? (For example: on schoolwork, tasks, extracurriculars, etc.) 

(1 = Very Happy, 5 = Very Unhappy)
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1
2
3
4
5
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How often do you hop around from one task to another without completing them? 
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Frequently
Sometimes
Rarely
Never
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How long does it usually take you to complete assignments compared to how long you think they should have taken? 
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Much shorter than expected
Shorter than expected
About the same as expected
Longer than expected
Much longer than expected
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What kinds of things are you most distracted by?
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Are you diagnosed with any health conditions that may impair your ability to focus? 
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Would you be interested in filling in a daily journal entry for our study running Monday to Friday next week? It will help you do more in less time going forward, and will only take ~10 mins per day!
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No
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What is the best way for us to contact you? (Phone number / Email)
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Are you under 18 years old?
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Section 2 of 2
Consent Form
For participants that are under 18 years old, we must collect consent from your parent/guardian. Please provide an email that we can use to contact them.
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First name
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Last name
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Are you a high school student?
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What year are you in?
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Where do you go to school? (School name, city)
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Are you happy with your ability to focus or would you like to be more focused? (For example: on schoolwork, tasks, extracurriculars, etc.) 

(1 = Very Happy, 5 = Very Unhappy)
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No responses yet for this question.
How often do you hop around from one task to another without completing them? 
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No responses yet for this question.
How long does it usually take you to complete assignments compared to how long you think they should have taken? 
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No responses yet for this question.
What kinds of things are you most distracted by?
No responses yet for this question.
Are you diagnosed with any health conditions that may impair your ability to focus? 
Copy chart
No responses yet for this question.
Would you be interested in filling in a daily journal entry for our study running Monday to Friday next week? It will help you do more in less time going forward, and will only take ~10 mins per day!
Copy chart
No responses yet for this question.
What is the best way for us to contact you? (Phone number / Email)
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No responses yet for this question.
Are you under 18 years old?
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No responses yet for this question.
Consent Form
Parent/guardian email address
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