Research Recruitment Application - National Stuttering Association

Application Contents

General & Contact Information
1. Name
2. Email
3. Address
4. Phone
5. Investigator Background

Description of Study
6. Title of proposed study
7. IRB Approval Letter*
8. Approved IRB Application*
9. Abstract
10. Research Timeline
11. Aims & Rationale
12. Research Procedures

*Required

13. Data Collection Tool(s)
14. Informed Consent Procedures
15. Confidentiality Procedures
16. Potential Risks (to participants)
17. Potential Benefits (to participants)
18. Potential Benefits (to investigators)
19. Funding
20. Anticipated Results

NSA Recruitment
21. NSA Recruitment
22. Recruitment Rationale
23. Potential Risks (to the NSA)
24. Proposed Recruitment Materials

Research Recruitment

1Contact Information

2Project Background

3Background Information

4NSA Recruitment

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.
Upload proposed data collection tool(s) (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.
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.
Hidden
Data from the study may be used for the following: (Check all that apply)*
(Check all that apply)
Data from the study may be used for the following: (Check all that apply)*
- Peer-Reviewed Publication
- Conference Presentation
- Pilot data for future study
- Doctoral Dissertation
- Master's Thesis
- Other

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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
- Other
If you selected 'other' above, please expand:
Tier 2*
- 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 proposed recruitment materials (i.e., email scripts, flyers)
Max. file size: 50 MB.

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Application Contents

Research Recruitment

Description of Study

NSA Recruitment

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