Clerc Center Research Request Form

Clerc Center Research

Request Form

This is the first step in requesting the Clerc Center's review of your research request. You will need to have your study's proposal, abstract, informed consent forms, a video release form (if applicable), recruitment materials, and CVs for all researchers ready before you fill out this application form. Once all information is filled out, the Clerc Center will determine if the study can be supported. If the Clerc Center can support the study, then a representative from the Monitoring, Evaluation and Research team will notify you. Incomplete application cannot be processed.

Principal Investigator's first and last name:*

Primary E-mail address:*

Primary phone number:

Co-Principal Investigator's first and last name (if applicable):

Which university, organization, or school is the Principal investigator(s) affiliated with?*

Please tell us your role for completing this form.

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What is your name?

What is your email address?

List the research team members responsible for data collection and/or in direct contact with study participants*

Will the principal investigator (s) be conducting this research, in part or in whole, to fulfill a college or university requirement?*

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If yes, please specify the requirement being fulfilled:*

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What level of research involvement are you requesting from/of the Clerc Center?*

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Title of research study*

Is the research request aligned with Clerc Center's Research Priorities?*

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If yes, which research priorities align with the research request?*

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This research study involves:*

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Briefly describe the purpose of your study.*

Which school are you requesting to conduct the study?*

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Who will be asked to participate in the study?*

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Do all research team members involved have their background checked?

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Clerc Center has families that uses a language other than English and ASL. Will you provide parents with letters and forms in another language besides English and ASL?*

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What is the proposed start date for Clerc Center's participation in the research study (including meetings prior to study implementation and participant recruitment)?*

What is the end date for Clerc Center's participation in the research study?*

Please list each measure or data collection activity for the study, and specify the group (e.g., teachers, school staff, parents, or students). Please also specify when, how often, and how long the measure or activity will be required of participants.*

Will you request school data for your study? (e.g.,demographics, performance data, and/or student data)*

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What school data will you request from the Clerc Center?

What assistance will you seek from the Clerc Center to support the research study? Select all that apply.*

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In what ways Clerc Center will benefit from the research study?*

Clerc Center requires all approved research requests to share their study results after the study concludes. How will the results be shared, ensuring they will be usable and readable for teachers , school professionals and families?*

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Do you have approval from Gallaudet IRB?

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Submit the following required documents in PDF: 1) Description of the study, 2) IRB application, 3) Consent forms, 4) Student assent forms (if apply), 5) demographic questionnaires, 6) surveys and any other measurement instrument.*

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