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$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:
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Investigator Title and Address:
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Email:
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Phone:
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NAPNAP Member
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Yes
No
Student
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Yes
No
Faculty Advisor, if appropriate:
*
School/Health Care Agency Affiliation/Organization:
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School/Health Care Agency Department:
Please upload a brief Bio-sketch or CV of the principal investigator and faculty advisor (if applicable):
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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:
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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:
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Please describe the timeline and anticipated date for distribution of the survey.
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Please describe how NAPNAP will be acknowledged in the final research or scholarship summary.
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Please include 300-word abstract of the study:
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0/300 words
Please include your research or project protocol:
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Please upload the email or cover letter that you would like to send out with your survey. Please note: emails cannot have attachments.
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Copy of the survey to be sent (Word or PDF):
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Please provide a discussion of the validity/reliability of your survey or development of your survey with psychometrics (if appropriate).
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Acknowledgement:
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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: