Create Participant Account | Institute for Successful Longevity

First Name

Last Name

Sex Male Female

Birth Date

Mailing Address

City

State

Email

Set Password

Cell Phone

Home Phone

Highest Level of Education

Current Marital Status

Do You Consider Yourself Hispanic or Latino? No Hispanic Latino

How would you describe your primary racial group? No Primary Group White/Caucasian Black/African American Asian American Indian/Alaska Native Native Hawaiian/Pacific Islander Multi-Racial Other

In which type of housing do you live? Residence hall/College dormitory House/Apartment/Condominium Senior housing (independent) Assisted living Nursing home Relative's home Other

Which category best describes your yearly household income? Less than $10,000 $10,000 - $19,999 $20,000 - $39,999 $40,000 - $59,999 $60,000 - $79,999 $80,000 or more Do not know for certain Do not wish to answer

Is English your primary language? Yes No

If "No", What is your primary language?

What is your primary occupational status? Work Full-time Work Part-time Student Homemaker Retired Volunteer Worker Seeking employment, laid off, etc. Other

If you are currently working, what is your primary occupation?

If retired, what was your primary occupation?

What kind of research would you be interested in participating in? (Choose all that apply)

Surveys and Questionnaires – Completing online or paper surveys about health, lifestyle, or aging.

Interviews or Focus Groups – Sharing personal experiences, opinions, or perspectives in a one-on-one or group setting.

Clinical Research Studies – Participating in health-related studies that may involve medical tests, lab visits, or physical exams.

Behavioral or Lifestyle Studies – Engaging in programs related to exercise, nutrition, sleep, or daily activities.

Technology & Digital Health Studies – Testing new apps, wearable devices, or digital tools for older adults.

Cognitive and Memory Research – Participating in activities to measure memory, thinking, or brain health.

Community Engagement Studies – Contributing to research on social connections, caregiving, or community-based interventions.

Other (please specify):

Which health topics are you most interested in? (Choose all that apply)

Do you have reliable access to a computer, smartphone, or internet connection?

Yes No Somewhat

Would you need transportation assistance for in-person research activities?

Yes No Maybe

Do you require any accommodations to comfortably participate in research (e.g., large print, hearing assistance, mobility support)?

What motivates you to participate in research? (Choose all that apply)

Advancing science and knowledge

Improving health for older adults

Learning more about my own health and wellness

Meeting new people and being socially engaged

Supporting Florida State University and ISL

Other (please specify):

How would you like to be contacted about research opportunities? (Choose all that apply)

Email

Phone call

Text message

Postal mail

Would you like to receive ISL updates/newsletters to stay informed about aging research?

Yes No

Create an Account

Please fill out the form below to be contacted about the latest research opportunities.

By submitting this form, you are agreeing to the Privacy Policy of the Institute for Successful Longevity.

To confirm your account, please solve the math problem at the bottom of the pages

Create an Account

Please fill out the form below to be contacted about the latest research opportunities.By submitting this form, you are agreeing to the Privacy Policy of the Institute for Successful Longevity.

To confirm your account, please solve the math problem at the bottom of the pages

Please fill out the form below to be contacted about the latest research opportunities.

By submitting this form, you are agreeing to the Privacy Policy of the Institute for Successful Longevity.