The purpose of this screening form is to see if you meet the criteria for taking part in our research study of Neurodiversity at Work.

This screening form will take approximately five minutes to complete. You will go through a list of questions. You may choose not to answer these questions. You also may choose to stop participating in this survey at any time.

Information about you that you provide during this interview will be kept as confidential as possible as required by law. It is possible that the Food and Drug Administration, and other federal and state authorities, may inspect this record.

You can choose if you want or do not want to take part in this research screening procedure – it is up to you. If you refuse to answer the questions or stop answering them at any time, there will be no penalty, and you will not lose any benefits to which you otherwise would be entitled.

The risk to taking part in this survey is very small. The screening form is not designed to ask you for sensitive personal information, but it is possible that some people may feel uncomfortable answering these questions. If you qualify to take part in the study and are interested in taking part in it, then we will record your name and information; this will be kept confidential, but there is a small risk that people outside of our research team could learn this information.

The benefit to you of taking part in this survey is that you will find out whether you can take part in the study of Neurodiversity at Work Program, which is a research program. This study involves a customized employment matching and onboarding procedure. You will not be paid for answering questions in this survey since it is only to see whether you qualify to take part in the study.

If you have any questions, concerns, or complaints about this screening form, please contact Dr. Lawrence Fung at (650) 498-9392. If you want to talk to someone separate from the research team about a concern or complaint or your rights as a possible research subject, please contact the Stanford Institutional Review Board (IRB) to speak to an informed person who is separate from the research team, at 650-723-5244 (for medical studies), 650-723-2480 (for nonmedical studies), or toll-free at 1-866-680-2906. In addition, please call the Stanford IRB at these numbers if you cannot reach the research team. Please print a copy of this page for your records.

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