Application Form
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Physical Activity Levels in the Built Environment

I would like to be considered as a participant in the research study on Physical Activity Levels in the Built Environment I understand that I will be asked to use devices provided by ISU to record my physical activity during four one-week periods over the next year, as well as to attend a pre-study and a post-study meeting.  

Note:   In order to be included in this study, you must be 18 years of age or older, you must walk or run regularly for exercise, and your walking/running activities during the four weeks of measurement must be within the Ames area.The information collected on this application will be used for selection purposes only and will not be included in the study. You will be notified if you have been selected for the study within the next two weeks.

The information collected on this application will be used for selection purposes only and will not be included in the study. You will be notified if you have been selected for the study within the next two weeks.

Name:sd

Address:

Phone: as (day)    (evening)     (cell)

Email:    

Age on September 15, 2005:

Gender: Male Female

Height:

Weight:

Describe your normal exercise habits:

Do you normally walk or run on the trails in Ames? Yes    No

Do you normally walk or run on sidewalks in Ames? Yes   No

In which neighborhoods?

If you have any questions about this study, please contact the principal investigator, Chris Seeger, Extension Landscape Architect, at 280 College of Design.   515.294.3648, or cjseeger@iastate.edu , or Susan Erickson, 326 College of Design, 515.294.1790, or susaneri@iastate.edu.

If you have any questions about the rights of research subjects or research-related injury, please contact the Human Subjects Research Office, 1138 Pearson Hall, (515) 294-4566; austingr@iastate.edu or the Research Compliance Officer, Office of Research Compliance, 1138 Pearson Hall, (515) 294-3115; dament@iastate.edu.