Research Recruitment Application - National Stuttering Association

1Contact Information

2Project Background

3Background Information

4Abstract

Name*
First Last
Email*
Address*
Institution Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Investigator Background*
Investigator Background and Qualifications (i.e., Education, research experience, etc.)

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Description of Study
Title of proposed study*
Upload an original copy of your IRB approval letter*
Max. file size: 50 MB.
Upload a copy of your approved IRB approved application*
Max. file size: 50 MB.
Abstract*
Please include an abstract (not exceeding 250 words) including: title, aim and rationale, name of primary investigator, and contact information, that will be placed on the NSA’s web page. 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.
Max. file size: 50 MB.
Upload a copy of proposed data collection tool (i.e., test instruments, surveys, interview questions).*
Max. file size: 50 MB.
Describe the study's informed consent procedures.*
This must include descriptions of data collection tools to be used including informed consent procedures.
Max. file size: 50 MB.
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.

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Describe the potential risks to participants.*
Describe any potential benefits to the participants.*
Disclose any potential benefits of this research to the investigator(s).*
If yes, please explain. Otherwise, simply indicate 'no'.
Is the proposed research funded? Yes/No?*
If yes, please list: PI, funding entity, and duration of funding.
It is anticipated the results from the proposed study will be ___:*
(Check all that apply)

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NSA Recruitment
Identify the mode of participant recruitment you are requesting from the NSA:
Tier 1 (limited to 3 studies per cycle)*
- Email blast to membership
- Email blast to select population
- Social Media post
Tier 2 (choose one)*
- Permission to recruit independently from local NSA Chapters
- Make study available on NSA "Participate in Research" Page
Provide a rationale for your recruitment*
Include any potential benefits to be gained by the NSA for promoting the proposed study. (i.e., create informational material to be distributed at the NSA Conference, acknowledge NSA in subsequent publications and/or presentations)
Are there any potential risks to NSA?*
Type Yes or No.
Upload proosed recruitment materials (i.e., email scripts, flyers)
Max. file size: 50 MB.

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Description of Study