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Research Funding Application

Contact Information

Description of Investigator

First name

Last name

Address

Phone

Investigator Biographical Sketch

Description of Study

Title of proposed study

Upload an original copy of your IRB approval letter

Upload a copy of your approved IRB approved application

Abstract

Please include an abstract (not exceeding 250 words) including: title, aim and rationale, name of primary investigator, and contact information. The abstract may serve to inform and recruit prospective participants

Research Timeline

When do you expect to begin your research, and what is its expected duration?

Describe the aims and rationale of the proposed research.

Describe the proposed research procedures

This must include descriptions of the data collection tools to be used including informed consent procedures.

Upload a copy of proposed data collection tool (i.e., test instruments, surveys, interview questions).

Background Information

Describe the study's informed consent procedures

Please upload any contact letters or script used to recruit participants.

Upload a copy of the informed consent form

Describe the procedures in place to protect the confidentiality and privacy of research participants

Please explain how the confidentiality of research participants will be protected, including procedures to permanently remove any links between research data and participant identity after the study is completed.

Describe the potential risks and benefits to participants.

Describe the potential risks and benefits to the NSA

Disclose any potential benefits of this research to investigators

Impact on the NSA

Is the study receiving funding from another entity?

Yes

If yes, please list: PI, funding entity, and duration of funding.

It is anticipated the results from the proposed study will be ___

Explain how funds will be used

How will funding this project benefit the NSA/people who stutter? (i.e., create informational material to be distributed at the NSA Conference, listing NSA as a funding entity on all publications/presentations associated with this study)

Research Funding Application

Contact Information

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