BRIDGE Screening Form

 
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The Australian DNA BRIDGE Study

Participant Screening Form

Thank you for your interest in the DNA BRIDGE study. To find out if you are eligible to participate, we kindly ask that you complete the following information. Completing the form does not mean you are agreeing to take part; it is the first step in the process. All information provided will be kept confidential and used only for the purpose of recruitment to DNA BRIDGE study.

[Asian ancestry means that a person’s biological parent (and their two parents) originates from Asia. This includes East Asia, South Asia, Southeast Asia, Central Asia, and West Asia. European ancestry means that a person’s biological parent (and their two parents) originates from Europe, including Western, Eastern, Northern, and Southern Europe]

Ancestry Inclusion CriteriaAncestry Inclusion Criteria
Family Tree Examples Showing Individuals With Mixed Ancestry​

What is the ancestral origin of your:
[Asian ancestry means that a person’s biological parent (and their two parents) originates from Asia. This includes East Asia, South Asia, Southeast Asia, Central Asia, and West Asia. European ancestry means that a person’s biological parent (and their two parents) originates from Europe, including Western, Eastern, Northern, and Southern Europe]

Paternal Maternal
Father Grandfather Grandmother Mother Grandfather Grandmother
[Asian ancestry means that a person’s biological parent (and their two parents) originates from Asia. This includes East Asia, South Asia, Southeast Asia, Central Asia, and West Asia. European ancestry means that a person’s biological parent (and their two parents) originates from Europe, including Western, Eastern, Northern, and Southern Europe]
[Asian ancestry means that a person’s biological parent (and their two parents) originates from Asia. This includes East Asia, South Asia, Southeast Asia, Central Asia, and West Asia. European ancestry means that a person’s biological parent (and their two parents) originates from Europe, including Western, Eastern, Northern, and Southern Europe]
[Asian ancestry means that a person’s biological parent (and their two parents) originates from Asia. This includes East Asia, South Asia, Southeast Asia, Central Asia, and West Asia. European ancestry means that a person’s biological parent (and their two parents) originates from Europe, including Western, Eastern, Northern, and Southern Europe]
[Asian ancestry means that a person’s biological parent (and their two parents) originates from Asia. This includes East Asia, South Asia, Southeast Asia, Central Asia, and West Asia. European ancestry means that a person’s biological parent (and their two parents) originates from Europe, including Western, Eastern, Northern, and Southern Europe]
[Asian ancestry means that a person’s biological parent (and their two parents) originates from Asia. This includes East Asia, South Asia, Southeast Asia, Central Asia, and West Asia. European ancestry means that a person’s biological parent (and their two parents) originates from Europe, including Western, Eastern, Northern, and Southern Europe]
[Asian ancestry means that a person’s biological parent (and their two parents) originates from Asia. This includes East Asia, South Asia, Southeast Asia, Central Asia, and West Asia. European ancestry means that a person’s biological parent (and their two parents) originates from Europe, including Western, Eastern, Northern, and Southern Europe]
Contact details



Collection of your information Privacy Statement
The personal information you are providing to us on this form is collected for the primary purpose of helping us to determine your eligibility for the BRIDGE study.
As part of this process, we may collect sensitive information from you. This includes information about your race and ethnic origin and other personal information relevant to your expression of interest that is included in the category of “sensitive information” under the Privacy Act 1988. By expressing your interest in participating in this research, you consent to us collecting that information for the purpose of recruitment for the BRIDGE study.
This information will be held independently and securely within the Human Studies Unit research portal database at University of Queensland with the local site investigator approving access to site specific staff. Access is through personalised logins and passwords for the research team and employs multi-factor authentication technology furthering securing the data.