ࡱ>  9bjbj c`c` 1zf f ts [9p l8888888$Q;>p9%%%99'''%R8'%8''67|7*&j78+90[976w>&w>$7w>7 ' 99' [9 ~Z# %%w> f q: 51 CPHPR Proposal Submission Form Submission Date:Click here to enter a date.Investigator:Click here to enter text.Email Address:Click here to enter text.Investigators Title/PositionClick here to enter text. Student Project Assistant(s):Click here to enter text. Name of Course that Student is Enrolled in for this Research Study (if applicable):Click here to enter text.Anticipated Start Date:Click here to enter a date.Anticipated End Date:Click here to enter a date.Anticipated Level of Review: Click here to enter text. If more than one Investigator, names of other Investigators and their titles/positions: Click here to enter text. Prior to submission to the CPHPR,all proposalsmust be reviewed by suitable person(s), knowledgeable in the field of study, for scientific merit andfeasibility. Such person(s) may not be a member of the CPHPR committee. Include the contact information of the individual(s) who reviewed this project for scientific merit and feasibility. The CPHPR may contact any named reviewer for more information regarding the scientific merit and feasibility of the study as needed. Name: Click here to enter text. Position Title: Click here to enter text. Phone: Click here to enter text. Email: Click here to enter text. Date of the review: Click here to enter a date. Reviewer Comments (optional): Click here to enter text. Project Funding: Externally Funded  FORMCHECKBOX Yes  FORMCHECKBOX No Internally Funded  FORMCHECKBOX Yes  FORMCHECKBOX No Please describe sources of funding. For externally-funded projects, please provide names of sponsors and grant numbers. Click here to enter text. Proposal Title: Click here to enter text. Briefly describe the questions/hypotheses you will address. Click here to enter text. In two or three paragraphs, briefly provide a rationale for your research project based on prior literature. Write so non-specialists will comprehend your project. Click here to enter text. Describe in detail the design of your project, or how you will analyze your data. Click here to enter text. Describe in detail all methods including the procedures and measures you will employ. Please attach appendices with the precise instruments, if applicable. Click here to enter text. Are you planning to use deception in your study? Choose an item. If so, justify its use. Note: The CPHPR discourages the use of active deception in research. Click here to enter text. Describe the debriefing session planned for the conclusion of your study. Note that a debriefing is required, particularly when deception is used. If you dont plan doing on a debriefing session because it would in any way limit the effectiveness of the study, please explain. (See example of a debriefing on the CPHPR website). Click here to enter text. Describe in detail all demographic information (age, gender, ethnicity, etc.) that you will collect. Click here to enter text. Describe the population that you will include in your research proposal and why you chose that population. Indicate whether you have any special knowledge of or experience with this sample population. Click here to enter text. Estimate the approximate number of participants you expect to include. [Please include a power analysis (if appropriate) and rationale for your N (number of participants) Please be cognizant of your colleagues and the students at 51 in asking for large numbers of participants]: Click here to enter text. Describe in detail how you will recruit your participants. Participating Emmanuel students must be 18 years of age or older. Describe the process you will use to ensure this age restriction is met. Indicate if you are using students in the Psychology Department Participant Pool. Please write verbatim the information you will post to recruit your participants. (Note: If you are recruiting participants from another institution, you may need to get approval from that institutions CPHPR or IRB, as well as from the 51 CPHPR. If the institution does not require its own IRB review, you may be asked to provide written documentation of the institutions support for your project. In most circumstances it is inappropriate for an investigator to use their own students as participants because of the possibility of coercion. Exceptions may be allowed, but the investigator would have to substantiate the need to use their own students as participants and propose an acceptable plan in accordance with CPHPR requirements and policies.) Click here to enter text. Please describe how you will obtain participants' approval. If you are obtaining consent/ permission/ assent, please attach the form(s) as appendices. The CPHPR is federally mandated to ensure that the consent process is free of coercion or undue influence. For research involving permission and assent, a complete description of the process must be included. The consent/permission form should be written at the level of an 8th grader. Please see the consent form template and sample consent form provided at the back of the guidebook. Click here to enter text. If you believe the CPHPR should waive the requirement of a signed consent form and you are not going to collect the form, please justify your decision here. If you are not going to distribute consent forms at all, please justify your decision here. Click here to enter text. Please describe any foreseeable risks that your research project could pose and assess their likelihood and seriousness. Note: Risk is a very broad concept for which Investigators should seek counsel from the CPHPR, if there are any questions. The CPHPR will examine the project to ensure that a wide range of risk issues are addressed- from the risk of information and identity disclosure to feelings of discomfort generated by questions on a survey to physiological discomfort or danger. There are other risks, but the preceding is intended to underscore the breadth of the concept. Click here to enter text. If risks are involved, describe procedures for protecting against or minimizing any potential risks identified above and assessment of likely effectiveness and seriousness: Click here to enter text. Describe any benefits that will accrue to participants themselves or to society: Click here to enter text. Will you be recording or collecting any identifiable, private information about individual participants that would allow an individual to be identified (for instance unusual ethnicity, birthdate, etc.)?  FORMCHECKBOX Yes  FORMCHECKBOX No 17.1 Will you be collecting audiotapes, videotapes, or still photography in your research?  FORMCHECKBOX Yes  FORMCHECKBOX No 17.2 If you answered yes to either question, describe a.) Which media will be used? and b.) How you will protect the privacy of your participants and maintain confidentiality, including provisions for secure storage of data after the completion of your research. (On the consent/permission form, you will need to inform participants or guardians of your intent to record, and you will need to describe what will happen to these records).Click here to enter text 17.3 If you answered yes, please read and sign below: I understand that I am obligated to protect and keep confidential any identifiable, private information gathered about individual participants through the conduct of my research. I agree to keep such information confidential, unless I obtain the participants express written permission to do otherwise or unless I am legally compelled to provide the information.  17.4 If you answered no, you will need to ensure that you protect the privacy of your participants and maintain confidentiality, including provisions for secure storage of data. Please describe how you will accomplish this: Click here to enter text. Does this proposal involve any of the following populations?  FORMCHECKBOX Children under 18 Years of Age  FORMCHECKBOX HIV Positive Individuals  FORMCHECKBOX Adults with cognitive impairments and/or institutionalized  FORMCHECKBOX Workers who could be penalized for participation  FORMCHECKBOX Prisoners  FORMCHECKBOX Physically Handicapped  FORMCHECKBOX Mentally/Emotionally Handicapped  FORMCHECKBOX Persons incapable of Informed Consent  FORMCHECKBOX None of the Above Is this project being reviewed by any other review board?  FORMCHECKBOX YES  FORMCHECKBOX NO If yes, provide name and location of other institution. Click here to enter text. Are you going to collaborate with any Emmanuel department or external agency or organization?  FORMCHECKBOX YES  FORMCHECKBOX NO If YES, please attach a letter of approval from the Emmanuel department or external agency. Completed Proposal Submission Forms must be sent via email to  HYPERLINK "mailto:CPHPR@emmanuel.edu" CPHPR@emmanuel.edu. Please do not send items related to the CPHPR to individual emails of the CPHPR Chair or Administrative Coordinator. Proposals are due 3 weeks PRIOR to the CPHPR meeting. Meeting dates are found on the website. Go to  HYPERLINK "http://www.emmanuel.edu/academics/research-at-emmanuel/committee-for-the-protection-of-human-participants-in-research.html" http://www.emmanuel.edu/academics/research-at-emmanuel/committee-for-the-protection-of-human-participants-in-research.html Note: All correspondence must be deposited in the CPHPR office files. A study cannot begin until this correspondence has been filed. Investigators with questions concerning the development, submission, or status of their proposal should contact Laurie Johnston, CPHPR Chair or Andrea Thomas, CPHPR Administrative Coordinator. Assurances: If a Consent Form is used, it is understood that it must be kept on file for three years. Participants must be given a copy of the consent Form. The CPHPR may request copies of signed Consent Forms for all participants participating in this research. It is understood that 51 students should be initially recruited as participants by public announcement and not by personal solicitation. If any project exceeds a period of one year in duration, it must be reviewed and receive CPHPR approval before the beginning of the second and any successive years of the project. It is understood that investigators must comply with the federally mandated educational training requirement. This is done by taking the online Course in the Protection of Human Research Participants, which is found at  HYPERLINK "https://citiprogram.org" https://citiprogram.org. There are CITI modules for Biomedical researchers, Social/Behavior/Educational researchers, and a module for student researchers and their research advisor. It also is understood that a study cannot be approved until all members of the research team have completed the necessary CITI training. The project investigator is responsible for monitoring the expiration of those training completion certificates for all members of the research team. If the CITI training certificate of any member of the research team will expire during the study, the project investigator is responsible for assuring that the member completes CITI refresher training before the expiration date. It is understood that any required financial disclosure documents must be signed before the project is approved. In signing this statement, I agree to the above-mentioned assurances, certify to the accuracy of the information provided in this document and in any attachments or other supporting documents, and reassert my intention to abide by the Colleges policies and procedures governing research involving human participants.  - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (For CPHPR use only)  FORMCHECKBOX Proposal Submission Form  FORMCHECKBOX Consent/Permission/Assent Form  FORMCHECKBOX Research Instruments  FORMCHECKBOX Recruitment Materials  FORMCHECKBOX Authorizations  Chair Email:  HYPERLINK "mailto:johnsla@emmanuel.edu?subject=CPHPR%20INQUIRY" johnsla@emmanuel.edu Recorded at CPHPR Full Meeting on Date: Click here to enter a date.     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