First Name

Middle Name

Last Name

Your Email Address

Your Date of Birth

Your Gender
FemaleMale

Your Height

Your Body Mass Index (BMI)

pQCT/DXA – Do you have any metal in your body other than dental work or most joint replacements? If so, please include location.

Are you claustrophobic?
YesNo

Do you have any the following? Allergies (including food), GI Disorders, Dietary Limitations
YesNo

Any cardiovascular issues?
YesNo

Any neurological disorders?
YesNo

Any musculoskeletal disorders?
YesNo

Are you taking any medications?
YesNo

Any sleep disorders such as sleep walking or use of sleep aids?
YesNo

Any motion sickness or simulator sickness to virtual reality? (NOT a disqualifier.)
YesNo

Any pharmacological treatment of ADHD?
YesNo

Any history of kidney stones?
YesNo

Any history of ulcers?
YesNo

Any history of epilepsy or other disorders of the brain?
YesNo

Any history of blood clots?
YesNo

Any history of close relatives with seizures?
YesNo

Are you currently on Bi-phosphonate? (For example: Fosamax, Boniva, Reclast?)
YesNo

Are you currently on any medications that might increase chances of seizures?
YesNo

Have you completed military officer training?
YesNo

Do you have any tattoos/permanent makeup? Only referring to your head, neck, or ear (If on any other part of the body, just reply ‘NO’)

YesNo

z. What is your highest level of STEM related field? (Must possess strong technical skills with a minimum of a Master of Science in a science, technology, engineering, or mathematics (STEM) discipline or have equivalent years of experience (education, profession, military)

Do you have a US Visa ?
YesNo

Have you previously been denied a visa to US?
YesNo