The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

ScrQqy734A2sZqYXqfLukFIF5pz3shv5hzI7xM7pNNcaMJUWTBfjUP5

Logbook Research Study Interest Form

Thank you for your interest in the Logbook Research Study. Unfortunately, we are not accepting further participants at this time. If you would like to be contacted regarding future research study opportunities, please leave your email address below.

Email Address:

* must provide value

Do you and your teen speak English?

* must provide value

Yes

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Is your teen 15-19 years old?

* must provide value

Yes

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Does your teen have a learner's permit?

* must provide value

Yes

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How much longer until your teen expects to get their license?

* must provide value

Less than 3 months

Less than 6 months

6 months or more

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Do you or your teen have a smartphone with a data plan?

* must provide value

Yes

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How old is the phone?

* must provide value

4 years or newer (made in 2016 or later)

Older than 4 years (made before 2016)

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Thank you for your time, but you are unfortunately not eligible to participate in this study.

You and your teen are eligible to participate in this study! As the next step, please complete the short questions below.

This information is stored securely and used only by researchers at Johns Hopkins to contact you regarding your interest. By filling out this form, you are giving permission to be contacted by the research team.

* must provide value

Click here to agree

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Parent/Guardian's first name:

* must provide value

Parent/Guardian's last name:

* must provide value

Parent's phone number:

* must provide value

Parent's email address:

* must provide value

Teen's first and last name (optional):

Teen's phone number (optional):

Teen's email address (optional):

Thank you! A member of our research team will contact you shortly to discuss your participation in this research study.

Please select the best times to reach you and click "submit."

Daytime, Weekday

Evening, Weekday

Daytime, Weekend

Evening, Weekend

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.