Research/Project Application

The Moog Center for Deaf Education

Where Deaf Children Talk

Research/Project Application

Research conducted at the Moog Center or involving Moog Center staff, students, and/or families must undergo review and be approved before it may begin. The Research Review Committee meets monthly and will respond to your request following review. Thank you for your interest.

Date:

MonthDayYear

Principal Investigator:

First NameLast Name

Affiliation:

Title:

E-mail:

Phone Number:

Area CodePhone Number

Contact information, if other than PI:

Name:

First NameLast Name

Title:

E-mail:

Please indicate reason for this request (check all that apply):

*Attach syllabus (if applicable) and provide the following:

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Instructor/ professor/ supervisor's name:

First NameLast Name

E-mail:

Phone Number:

Area CodePhone Number

______________________________________________________________________________________________

Will Moog staff be engaged in this research? (for guidance on engagement see http://www.hhs.gov/ohrp/policy/engage08.html)

If Yes, please specify name:

What is the project timeline? Describe when it is proposed to start and finish:

Where will the research take place?

If offsite, where?

If other, please specify (phone, mail, email, etc.):

Has protection of human subjects training (e.g., CITI, NIH, other) been completed by all engaged investigators?

If yes, please attach copy of certification and modules completed:

Upload a File

Has HIPAA training been completed by all investigators?

If yes, please attach copy of certification and modules completed:

Upload a File

Briefly describe proposed research/project in lay language (do not cut and paste from your protocol/grant):

If IRB Approval has been received, please attach approval letter:

Upload a File

If IRB Approval has not yet been received, please complete the following as applicable:

If you have applied, but it is not yet been received, please list where and when you applied:

If you have NOT yet applied, but plan to, where and when do you plan to apply?

If the project is exempt, who made that determination?

If the project is not human subject research, who made that determination?

Was Moog included in IRB application recruitment plan?

All applications must include complete research protocol or grant proposal, IRB application (include any modifications/continuing reviews, etc.), consent forms, recruitment documents/script, survey instruments, or other pertinent documents to support your application.

Additional Attached Documents

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