Volunteer Registration Forms

Part of the pre-screening process for volunteers to participate in any of the EPA Clinical Study opportunities require that you download and fill out the forms below. These forms allow for fill-n-print and therefore could be faxed or mailed to the EPA Studies Recruitment Team.

List of forms:

• Consent to Participate in an EPA Research Study Form (IRB Study: 95-0518) (pdf) (199 KB, 09/08/2020)
• EPA Clinical Studies Facility Medical History Questionnaire (pdf) (696.4 KB)
  Part of the pre-screening process for volunteers to participate in any of the EPA Clinical Study opportunities require that you download and fill out the form that is attached.
• EPA Clinical Studies Physical Activity Questionnaire Form (pdf) (300.54 KB)
  Part of the pre-screening process for volunteers to participate in any of the EPA Clinical Study opportunities require that you download and fill out the form like the one attached.
• HIPAA Authorization for Use and Disclosure Form (IRB Study: 95-0518) (pdf) (158.92 KB, 09/08/2020)
• MPF Federal Procedure for Research Volunteer Reimbursement Form (pdf) (133.86 KB)
• Collection of Social Security Number for Payment to Research Volunteers Form (pdf) (25.38 KB)

Mail completed forms to:

MPF Federal/EPA Recruitment Team
104 Mason Farm Road, Suite 1 Campus Box 7315
Chapel Hill, NC 27599

Or fax to:

919-966-0605

Please include a title page with the text "EPA Studies Recruitment Team Form Submission."