[Ex] 学習に関する脳波計測実験(3時間,謝金約3,000円)EEG experiment for human learning research (three hour, about 3,000 yen)
これは実験参加登録フォームの例です.このフォームから実験には応募できません.
This is an example for a registration form for participating in our experiment. You can not apply to the experiment by this form.

実験責任者:
京都大学情報学研究科 〇〇〇〇
abc@defg.ac.jp

日時:
2019年XX月XX日-からXX月XX日の期間で実施

内容:
学習に関する行動計測実験です.
実験は,ディスプレイに表示される記号を観察し,記号に応じてマウスクリックで応答するものです.
脳波計測も行いますので,脳波キャップと電極を頭部に装着します.
また,頭皮と顔表面にジェルを塗るため,実験の前後で洗髪をしていただきます.

所要時間:
3時間程度

場所:
京都大学吉田キャンパス本部構内総合研究10号館417号室(石井研究室実験準備室)
総合研究10号館はキャンパスマップの60番の建物です.
http://www.kyoto-u.ac.jp/ja/access/campus/yoshida/map6r_y/

謝金:
京都大学の規定に基づき,3000円程度.
謝金の支払いは銀行振込によって行われます.
ご自身の銀行口座が必要です.

備考・注意事項:
・視線・姿勢の固定などの指示を行います.
・洗髪で使うタオルなどはこちらでご用意します.
・実験や脳波への影響があるため,実験前日は十分な睡眠を取るようにお願いします.

以下のメニューから必要事項を記入の上,実験参加可能な日時を選択してください(複数選択可).

回答送信後,入力されたメールアドレスに回答内容が送信されます.
メールを受信できない場合,メールアドレスを間違って入力した可能性がありますので,もう一度ご回答下さい.

回答された方にメールで連絡し,実験日時を調整します.
日時が確定された方は,予約日時に京都大学吉田キャンパス本部構内総合研究10号館417号室(石井研究室実験準備室)までお越しください.

回答いただいた情報は日程調整や必要書類の準備のためのみに使用されます.

LINE(https://line.me/R/ti/p/%40ifs5612v)で問い合わせることも可能です.
その場合は友達追加後,トークで所属と名前を入力してください.
入力後,こちらからの連絡が可能になります.


Contact:
XXX XXX, Graduate School for Informatics, Kyoto University
abc@defg.ac.jp

Date:
We are going to conduct the experiment between April XX and April XX, 2019.

Tasks:
This experiment measures your behavior during you solve a learning task.
In the task, you observe some symbols on a PC display and respond by mouse-click.
We record your EEGs and install electrodes by a special cap.
We apply conductive gel on your head and face skins and you need to wash your hair before and after the experiment.

Experimental time:
About three hour.

Location:
Our experimental room.
#417, Research Bldg. No.10, Yoshida Main Campus
The east end of the 4th floor of the building no. 60 (Research Bldg. No.10) in the following campus map.
https://www.kyoto-u.ac.jp/en/access/main-campus-map.html

Monetary gratuity:
About 3,000 yen.
The money is paid by bank transfer and your own bank account is needed.

Requirements:
- We ask you to hold still as much as possible.
- We ask you to wash your hair before and after the experiment. We have a sink for hair wash in the experiment room and you can use our you towels.
- You might have sleepy during the experiment. Please take sleep well the night before the experiment to record good quality data.

Please choose time slots when you can participate in the experiment.
You can choose multiple slots.

After you send this form, the copy of the form will be sent to your mail address.
If you do not receive the copy, you could fill a wrong mail address.
Please confirm your mail address and resend the form again.

We reply you to arrange your experiment date and time by email.
Please visit the experimental location (#417, Research Bldg. No.10, Yoshida Main Campus) at the appointed time.

The information you fill in this form is used only for this experiment.

You can contact with us via LINE (https://line.me/R/ti/p/%40ifs5612v).
To valid out talk via LINE, please input your name and department at the beginning of the talk.
Email address *
氏名 Name *
Your answer
氏名のふりがな Hiragana of your name
Your answer
所属 Department *
例えば情報学研究科,工学部電気電子工学科.Ex: Graduate School of Informatics, Undergraduate School of Electrical and Electronic Engineering
Your answer
住所 Address *
例えば京都府京都市左京区吉田本町36-1(建物名)〇〇号室.Ex: #(room number), (building name), Yoshidahonmachi 36-1, Sakyo-ku, Kyoto
Your answer
参加希望日時 Available slots for participation
実験に参加できる日時を選んでください(複数回答可)Please choose time slots you can participate in the experiment. You can choose multiple slots.
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
5月AA日 May AA (Mon)
5月BB日 May BB (Tue)
5月CC日 May CC (Wed)
5月DD日 May DD (Thu)
5月EE日 May EE (Fri)
ご要望・質問 Requests and Questions
質問以外にも,「月曜日は終日可能」といった日程調整についてのご要望もお書き下さい.Beside requests and questions, you can request for experiment schedule. Ex: I can participate the experiment every Monday.
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service