ࡱ> JLI` bjbjss @.C  8 &$ Y+Vl"iiia!c!c!c!O!F&*$,hS/* ii* +^^^X  a!^a!^^:U , J TGp a!)+0Y+ R/|/ / ih^cT iii**XiiiY+ $    SAN JOSE STATE UNIVERSITY SCHOOL OF NURSING Application for Project Advisors or Thesis Readers 1. Create a title page with the (tentative) title of your research project, your name, phone number, PeopleSoft#, email address, and your probable date of graduation. 2. Include a brief description of your research idea, including your proposed methodology (eg. Is this a survey, a pre- and post-test design, quasi- experimental design, qualitative interview study, a review of existing documents, or some other design?) 3. Research Question(s) or queries, and, if applicable, hypothesis. 4. Discussion of subjects, recruitment, and protection of subjects: 4.1 Subjects/participants: How many participants will you try to have? If relevant, include ages, demographic criteria, and why you chose them. 4.2 Procedures you will use to obtain subjects: Describe how they will be recruited. Explain who and where the potential participants are, how they will be contacted, what will be said to recruit them and by whom. If you will be advertising or putting up signs, please include the texts of such recruitment tools. 4.3 Identify the benefits, if any, for the participants in the study. 4.4 Identify any possible risks to the participants and how you will deal with those risks. 4.5 Will any compensation be awarded to the subjects for participating in the study? Explain. 4.6 Complete the Human Participation Protections Education for Research Teams online course, print out Completion Certificate include with this application at  HYPERLINK "http://cme.cancer.gov/clinicaltrials/learning/humanparticipant-protections.asp" http://cme.cancer.gov/clinicaltrials/learning/humanparticipant-protections.asp 5. Research materials, devices, instruments, equipment. 5.1 Describe all instruments to be used (eg. psychological, educational, or evaluative tests; demographic questionnaire; interview guide). Please attach copies of these tools (if you have them) and any letters requesting and/or granting permission for their use. 5.2 Will special equipment be used, physiologic measures, or photographic equipment? Explain their use. 6. Procedures: 6.1 State where, when, and by whom the research will be conducted. If using an agency (hospital, school, private practice, etc.), attach letters requesting/granting you permission to recruit from or carry out your research in that agency. 6.2 Describe what participants will be asked to do, step-by-step. 6.3 If a treatment or intervention is to be carried out, describe it and include the qualifications of the person providing the treatment/intervention. 7. Confidentiality: Describe the mechanisms for maintaining confidentiality. Explain how data will be collected, stored, and who will have access to the data. If any identifying personal data (eg. names) will be collected with the data (eg. to keep track of several interviews or to collect data at several different times), explain how you will store the identifying information away from the data. 8. Consent form: 8.1 Attach a draft of the consent form that you will use. Refer to the guide from IRB to help you with this draft. Your advisor can help you revise this consent form, but you need to provide a first draft. The final version will need to be printed on School of Nursing letterhead before the consent form goes to the IRB for review. Ask your advisor or N297 instructor for letterhead. 8.2 If you plan to recruit 91 nursing students you must request permission from the Chair of the Program Evaluation and Research Committee (see sample request) and include with this Application. 9. Describe how data will be analyzed. If this is a quantitative study, include with as much clarity as you can, the statistical procedures you will use, and whether you will be using the services of a statistician. If this is a qualitative study, describe which qualitative analysis method(s) you will follow. 10. Attach a proposed time line for your research, with enough detail that your reader will know when you plan to do which pieces of the project, when you will finish writing and submit the manuscript, and when you plan to graduate. 11. Have you spoken with any faculty about your research ideas Please provide the names of faculty whom you might like to have as advisor(s) (faculty who share your clinical interest, for example). [If you are doing a thesis, are there any masters prepared community members who have expressed an interest in working with you on your research?] 12. Turn in the above materials along with a photocopy of the list all courses from mysjsu on the internet completed and those which you are currently enrolled in. All Incompletes must be completed and all Conditions met prior to being assigned Project Advisors. PROVIDE 3 COPIES OF THIS APPLICATION TO DR. CONNOLLY If you are using 91 nursing students provide a 4th copy for the Program Evaluation and Research Committee     PAGE  PAGE 2 Rev. 1/04;6/05;9/05;12/05;1/08 ,^ * '(+46Xz{|15X|}ǵҨǝthhh0OJQJhhhD(1OJQJh OJQJhhh*OJQJhhh]OJQJhhha-0J&OJQJ#jhhha-OJQJUhhha-OJQJjhhha-OJQJUh0OJQJhhh >*OJQJhhh OJQJ*,_` [  V . {  ^ x   o ^gda-^$a$]!l4|0{|&s 0` 0^`0}~(|`Ii & Fgd8O h^hgdD:`gd}:gd}:^hrst RȼȰȡyuyuyuyukekeakekekhD(1 hD(10J%jhD(10J%UhPZjhPZU hhhh56>*H*OJQJhhhh56>*OJQJhhhB56>*OJQJhhh}:5OJQJhhh8O 5OJQJhhhD:5OJQJhhhAOJQJhhh}:OJQJhhh OJQJhhhD:OJQJ&$h]ha$h]h&`#$gdB h,^h`,gd8O hhhB56>*OJQJhPZhD(1hD(15CJ\ hD(10J%> 00PBP/ =!"#$%0 $DyK Ohttp://cme.cancer.gov/clinicaltrials/learning/humanparticipant-protections.aspyK http://cme.cancer.gov/clinicaltrials/learning/humanparticipant-protections.asp(<@< NormalCJ_HmH sH tH DA@D Default Paragraph FontViV  Table Normal :V 44 la (k(No List lOlDefaultd1$7$8$H$0B*CJOJPJQJ_HmHnHphsH tH u@O@Hidden0B*CJEHOJQJphFOF Default SSB*CJEHOJQJphh@"hHeader$d1$7$8$H$a$'5B*CJOJPJQJmHnHphufO2fBodyd1$7$8$H$0B*CJOJPJQJ_HmHnHphsH tH ud @BdFooter$d1$7$8$H$a$#6B*OJPJQJmHnHphujORjFootnoted1$7$8$H$,B*OJPJQJ_HmHnHphsH tH uPOaP Footnote IndexB*CJEHH*OJQJph*O1r*Hidden1@O@Hidden2B*CJEHOJQJph0O10Hidden3$a$@O@Hidden4B*CJEHOJQJphBOBHidden5>*B*CJEHOJQJph@O@Hidden6B*CJEHOJQJph*O1*Hidden7@O@Hidden8B*CJEHOJQJphBOBHidden9>*B*CJEHOJQJphDODHidden10>*B*CJEHOJQJph,O1,Hidden11!BO!BHidden12B*CJEHOJQJphBO1BHidden13B*CJEHOJQJphDOADHidden14>*B*CJEHOJQJph.)@Q. 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L^`LhH.Tn         L*/        =[8O F#a-D(1SPZ]Jm2?nPzk{A0hB5/T +}:*l|D:o@HP LaserJet 2100 Series PCL 6 newLPT1:winspoolHP LaserJet 2100 Series PCL 6HP LaserJet 2100 Series PCL 6 ?dLetter.HP LaserJet 2100 Series PCL 62rxePNSQ] W*,x@jդ3" IVHBt&0aƔ#>O07{ {Yks֩.W@T2s^6RUxr^u Q D)΅V;0/ڨY&᪥V/"zkY[Ju!o3\HP LaserJet 2100 Series PCL 6 ?dLetter.HP LaserJet 2100 Series PCL 62rxePNSQ] W*,x@jդ3" IVHBt&0aƔ#>O07{ {Yks֩.W@T2s^6RUxr^u Q D)΅V;0/ڨY&᪥V/"zkY[Ju!o3\{ { m{ { @UnknownGz Times New Roman5Symbol3& z Arial3z Times;& z Helvetica5"Geneva5& zaTahoma hӼfӼff # #!xx4{2qHX?Pz2SAN JOSE STATE UNIVERSITYSusan O. MurphyPhyllis Connolly  Oh+'0 ( H T ` lxSAN JOSE STATE UNIVERSITYSusan O. Murphy Normal.dotPhyllis Connolly5Microsoft Office Word@@fФ@ؕG@|)G՜.+,D՜.+,D hp|  #  SAN JOSE STATE UNIVERSITY Title  8@ _PID_HLINKSAdOhttp://cme.cancer.gov/clinicaltrials/learning/humanparticipant-protections.asp  !"#$%&'()*+,-./012345678:;<=>?@BCDEFGHKRoot Entry FXGMData 1Table 0WordDocument@.SummaryInformation(9DocumentSummaryInformation8ACompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q