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Xlab Experiment Request Form


Primary Contact:
Phone #:
Email:
Department:
UCB Status:
Faculty
Graduate Student
Postdoc/Visiting Scholar

Principal Investigator/ Faculty Sponsor Name:
Principal Investigator/ Faculty Sponsor E-mail:

ABOUT YOUR EXPERIMENT

Title of Experiment:

Brief description of the experiment:


Does this experiment involve deception?
Yes
No

If you have any special procedures/requirements and room configuration needs for your experiment, please describe them below:



SUBJECT RECRUITMENT

Do you need Xlab subject recruitment services?
Yes
No

Minimum number of subjects needed per session:
Maximum number of subjects needed per session:
Total number of sessions needed:

Subject pool (Mark all that apply):
Student
Staff
Alumni (for remote online or mobile phone experiments only)

Please describe subject requirements and/or restrictions if any (i.e. gender; race; pairs, multiples of 3; similar protocol (from your series), experience with study designs like dictator games, etc.).

SUBJECT PAYMENT

Do you have funding for subject payment?
No
Yes

If yes, what is your source and amount of subject payment funding?

Xlab Grant $
Own research fund $
    Funding Contact Name (not PI)
    Funding Contact Email:
    Fund source/Chartstring:

Do you require Xlab subject payment services?
Yes
No

Subject Payment Type:
Flat Fee Payment
Variable Payment Range

Subject Payment Method:
Check
Amazon Gift Code
UC Berkeley Prepaid Virtual Visa
Self-service (Cash, Square Cash, Paypal)


EXPERIMENT TYPE

Please choose one:
Paper Experiment
Computer Experiment
Online Experiment
Other Experiment

Would you like to run after-hours or weekend sessions? (Self-service)
Yes
No


COMPUTER-BASED EXPERIMENTS

Would you like to be contacted by the Technology Support Manager for a consultation?
Yes
No

What software will be used?
Firefox Browser
IE Browser
Z-tree
Inquisit
Medialab/DirectRT
Special Software that I will provide:

Please provide additional details of your hardware and software requirements.


QUESTIONS?

Please direct CPHS-related questions to OPHS staff
You will be contacted by the Xlab Staff shortly after submitting this form.