$50.00 review fee (non-refundable) for NAPNAP members and student members
$100.00 review fee (non-refundable) for non-members and organizations

NAPNAP Research and Scholarship Access Request Form

Investigator Name: *

Investigator Title and Address: *

Email: *

Phone: *

NAPNAP Member *

Yes

Student *

Yes

Faculty Advisor, if appropriate: *

School/Health Care Agency Affiliation/Organization: *

School/Health Care Agency Department:

Please upload a brief Bio-sketch or CV of the principal investigator and faculty advisor (if applicable): *

Please provide documentation of IRB review and determination. Note: IRB is required to process the application. *

Please provide additional information about IRB review, if necessary.

Please identify who you would like to distribute your survey to: *

NAPNAP General Membership (additional fee of $500 for members, $650 for non-member individuals and $1,300 for organizations is required) Please note: This option is not available for student members

NAPNAP Chapter: please list below (requires approval of chapter president)

NAPNAP SIG: please list below (requires approval of SIG chair)

Please list Chapter or SIG Please list Chapter or SIG

Publication to which a manuscript will be sent: *

Please describe the timeline and anticipated date for distribution of the survey. *

Please describe how NAPNAP will be acknowledged in the final research or scholarship summary. *

Please include 300-word abstract of the study: *

0/300 words

Please include your research or project protocol: *

Please upload the email or cover letter that you would like to send out with your survey. Please note: emails cannot have attachments. *

Copy of the survey to be sent (Word or PDF): *

Please provide a discussion of the validity/reliability of your survey or development of your survey with psychometrics (if appropriate). *

Acknowledgement: *

I agree to acknowledge the source of my data as described above.

I agree to send a summary of the results NAPNAP Research Committee after completion of my survey (within 3 months).

Please provide your name here, acknowledging the above: *

Faculty acknowledgement (if applicable):

I verify that my faculty advisor has reviewed the research proposal and the surveys/tools, and has agreed to provide guidance to assist me with completing the research.

Faculty Name:

Faculty Email: