CFMAL Research Division Question Title * 1. What is your last name? Question Title * 2. What is your first name? Question Title * 3. What is your age? 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 Question Title * 4. What is your gender? Female Male Question Title * 5. At what email address would you like to be contacted? Question Title * 6. Please provide a contact phone number: Question Title * 7. Are you a current student at LCC? Yes No Question Title * 8. Do you have a medical condition causing significant chronic pain or disability? Yes No Question Title * 9. Have you ever applied, or are you planning to apply for disability benefits based on an on-the-job injury? Yes No Question Title * 10. Do you meet the other criteria for participation as described in the explanation provided by Dr. Bolyard and Dr. Meharg? Yes No Submit