Faculty members and students who wish to conduct research at the Hoya Kids Learning Center (HKLC) must submit this form along with approval from the Institutional Review Board (IRB) to the Center Director. If the basic guidelines are met (See Guidelines for Conducting Research at the Hoya Kids Learning Center), then it will be passed on to the HKLC Research Committee for review. Reviews will typically take place in March, June, September, and December.
Name:___________________________________________________________
Date of request:____________________________________________________
College/Department/Program: _________________________________________
Date of IRB approval: _______________________________________________
Phone / Email : ____________________________________________________
Please include a copy of the following:
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Resume or CV
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Letter of reference from sponsoring faculty member or department chair
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Results of current TB test (for any and all researchers or assistants that would interact with children in any way)
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D.C. Criminal background check (for any and all researchers or assistants that would interact with children in any way)
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Copy of the consent form (for those investigators proposing interaction with children in any way)
If you are a student, describe the course assignment or the degree requirement this research is fulfilling:
On a separate sheet, please include the following:
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A brief description of the purpose of this research.
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A brief description of your methodology.
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What instruments / measures will be used to obtain the data?
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How many / what age children do you plan to study / observe?
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What is the expected time frame of your involvement at the Center? / When would you like to begin collecting data? / When do you expect your data collection to be complete?
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What days / times would you like to conduct your research? / If you intend to interact with children you must attach a copy of the consent form you will send home to parents / guardians.
Please plan to share copies of accepted manuscripts, papers and presentations based on your involvement at the center with parents, staff and the research committee. This documentation is important for our records.
I certify that the above research proposal is true. Major changes will not be made without notifying the Hoya Kids Learning Center Research Committee. I agree to consistently maintain all individuals? confidentiality and to show respect for children, parents, teachers and their work together.
Singnature: _______________________________________________________
Phone: __________________________________________________________
Send this application to:
Jane Banister, Hoya Kids Learning Center, 3624 P. St. NW, Box 571219; Phone: 687-7667, Fax: 687-1192
