What is your last name?

Question Title

* 1. What is your last name?

What is your first name?

Question Title

* 2. What is your first name?

What is your age?

Question Title

* 3. What is your age?

What is your gender?

Question Title

* 4. What is your gender?

At what email address would you like to be contacted?

Question Title

* 5. At what email address would you like to be contacted?

Please provide a contact phone number:

Question Title

* 6. Please provide a contact phone number:

Are you a current student at LCC?

Question Title

* 7. Are you a current student at LCC?

Do you have a medical condition causing significant chronic pain or disability?

Question Title

* 8. Do you have a medical condition causing significant chronic pain or disability?

Have you ever applied, or are you planning to apply for disability benefits based on an on-the-job injury?

Question Title

* 9. Have you ever applied, or are you planning to apply for disability benefits based on an on-the-job injury?

Do you meet the other criteria for participation as described in the explanation provided by Dr. Bolyard and Dr. Meharg?

Question Title

* 10. Do you meet the other criteria for participation as described in the explanation provided by Dr. Bolyard and Dr. Meharg?

T