Nichols Research
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Apply For An Upcoming Study

Before proceeding, please review our Privacy Policy for your assurance of our commitment to the protection of your information. Please note; your attendance is recorded and missed appointments may result in not being called for future studies. If you agree to this commitment, are 15 years of age or older, and you have read our Privacy Policy, please continue completing your information below.

Areas marked with an asterisk (*) are required
Referred By: *
First Name *
Last Name *
Male Female
Date of Birth
Work Phone *
Work Phone Ext
Home Phone (if we may call you at home)
Cell Phone (if we may call you on your cell)
Cell Phone Carrier?
May we text message you?
Yes No
Email Address (Primary) *
Email Address (Secondary)
City *
State *
County *
Zip *
Employment Status *
Department you work in *
Job Title *
Level you report to
Company (No Abbreviations, please) *
Company Industry *
Industry (specific)
Employees (Global) *
Company Annual Revenue
Business Travel per Year
Computer at Work
No computer at work PC/Compatible Apple/Mactintosh compatible Other type
Mobile Technology

(Hold down the 'Ctrl' key on PC, 'Command' key on Mac, while clicking to make multiple selections)

Please Note: We cannot extend an invitation to anyone without going through a preliminary questionnaire over the phone. Please be aware that you will not be scheduled for this study until you have been screened and officially invited. We cannot guarantee that we will call back everyone who responds once a project has been completed. The groups may be filled by the time you respond to this message.