Participant Application | Baum Neuroscience Institute

Basic Information

Full legal name

Email address

Current school or employer

Are you currently enrolled at the college? Yes No

Are you at least 18 years old? Yes No

Artistic Background

Which disciplines are you interested in developing?

Select all that apply.

Drawing or painting Sculpture Photography Film or animation Graphic design Music Creative writing Performance Other

How would you describe your current experience? No formal experience Beginner Intermediate Advanced Professional

What has prevented you from developing this skill through conventional study or practice?

Please describe something you have wanted to create but have been unable to make.

If you could acquire one artistic ability immediately, what would it be—and what would you do with it?

Health and Eligibility

Have you ever experienced any of the following?

Select all that apply.

Seizures or epilepsy Traumatic brain injury Neurological illness Chronic migraines Fainting or loss of consciousness Severe sleep disturbances Psychiatric hospitalization Implanted medical devices Adverse reactions to anesthesia None of the above

Would you be willing to undergo neurological imaging, cognitive testing, surgery, and supervised recovery? Yes No I would like more information

Participation

The study may involve temporary or persistent side effects, including headache, nausea, fatigue, memory disruption, sensory distortion, mood changes, sleep disturbance, and effects that are not yet known. Do you understand that participation involves experimental risk? I understand I would like to discuss these risks with the research team I do not wish to continue

Are you available for the complete study period, including calibration, implantation, residential observation, testing, and follow-up appointments? Yes No

Would you be willing to refrain from alcohol, recreational drugs, and non-approved medications during the study? Yes No

Do you have a trusted person who could assist you during recovery? Yes No

Would you consent to your creative work and anonymized study results being used for research, educational, or promotional purposes? Research only Research and education Research, education, and promotion I would like more information

Motivation

Why do you want to participate in this study?

What would successful participation change about your life?

What concerns you most about the study?

If the skills acquired through the program changed your sense of identity or authorship, how do you believe you would respond?

Acknowledgment

I understand that this is a preliminary application, not informed consent or confirmation of acceptance. If selected for further screening, I will receive additional information about the procedure, its known risks, alternative options, confidentiality, compensation, and my right to withdraw.

I have read and understand the statement above

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