bilingual study form Impact of bilingualism on intelligibility of child and adolescent speech "*" indicates required fields 1Waiver of Signed Consent for Adult Participants2Eligibility form Thank you for your interest in our study titled “Impact of bilingualism on intelligibility of child and adolescent speech”. For this project, we are recruiting adults from 21 years to 35 years of age who have normal hearing, no known disabilities, and speak English as their primary language or are bilingual in English and one or more other languages. The information we gather from you will help us to identify and characterize clinical features related to speech production of children and adolescents with and without speech disorders. If you are interested in potentially participating in this study, we ask that you provide us with some basic information so that we can determine whether you are eligible for the study and so that we can contact you later to schedule an appointment. By checking the box below, you are giving us permission to contact you regarding participating in the study if you qualify.* I agree Is English the first language you learned, and the primary language used at home when you were growing up?* Yes No How many languages do you know and use?*Please enter a number from 1 to 10.Please list all the languages you know and speak then rate your ability to speak the language using the scale below. (Sample response: Tagalog – 10) 1 - very low ability to speak 6 - slightly more than adequate ability to speak 2 - low ability to speak 7 - good ability to speak 3 - fair ability to speak 8 - very good ability to speak 4 - slightly less than adequate ability to speak 9 - excellent ability to speak 5 - adequate ability to speak 10 - native-like ability to speak Language 1* Language 2* Language 3* Language 4* Language 5* Language 6* Language 7* Language 8* Language 9* Language 10* Are you between the ages of 21-35?* Yes No Do you have a history of hearing loss?* Yes No Have you ever had a head injury or concussion?* Yes No If yes, was it in the last year?* Yes No Do you have a vision impairment that is not corrected?* Yes No Have you been diagnosed with a language or learning disability* Yes No Have you participated in this study or a similar study from our lab within the past 12 months?* Yes No If yes, when did you participate?* What is your name?* First Last What is the best number to contact you?*What is your email address?* How did you hear about our study?* EmailThis field is for validation purposes and should be left unchanged.