Background Questionnaire
We are asking for the following information because it will help us determine if you qualify for the perceptual training experiment.
1. Please enter your age:
2. Please select your gender:
Male
Female
Other
Prefer not to say
3. Are you:
Right-handed
Left-handed
Ambidextrous
4. Where have you lived and how old were you when you lived there?
Please input the age at which you began living in each location, and the age at which you left.
Location
City
Country
Starting age
Ending age
#1
#2
#3
#4
#5
#6
#7
#8
#9
#10
5. Where are your parents from?
Parent
City
Country
Father
Mother
Father
Mother
6. What language(s) did your parents speak while you were growing up?
Parent
Language
1
Father
Mother
2
Father
Mother
3
Father
Mother
4
Father
Mother
5
Father
Mother
6
Father
Mother
7. List any languages that you might know, the age at which you first started learning that language,
and your proficiency in reading, writing and speaking each language (where 1 = poor and 5 = excellent).
Language
Age
Speaking
Proficiency
Writing
Proficiency
Reading
Proficiency
1
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
2
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
3
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
4
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
6
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
8. Do you have any speech or hearing impairments?
Yes
No
If yes, please describe.
9. Your name:
10. Your e-mail: