Diablo Valley College Internal Research Request Form Question Title * 1. Contact Information Name Email Address Phone Number Question Title * 2. Which of the following most accurately describes you? Classified Professional Faculty member Administrator Other (please specify) Question Title * 3. Please name any other institutions to whom you have reached out to conduct this research. Input N/A if DVC is the only institution. Question Title * 4. Title of study Question Title * 5. Duration of study: What semester(s) will your research be conducted? What are your research project's intended start and end dates? Question Title * 6. What is/are your research question(s)? What would you like to know? Question Title * 7. Who is your intended audience for your published research? Where do you hope to publish it? If you are not planning to publish your research, please type N/A. Question Title * 8. Please select the participants of your research. Check all that apply. Students Faculty Classified professionals Administrators Other (please specify) Question Title * 9. Describe the methodology for your research. Question Title * 10. If applicable, upload a copy of your instrument or provide a link to it (e.g., surveys, focus group questions, etc.) PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File If applicable, upload a copy of your instrument or provide a link to it (e.g., surveys, focus group questions, etc.) Question Title * 11. Describe how you plan to recruit participants for your research. Question Title * 12. Describe how your research will benefit the DVC student body and community? Question Title * 13. Describe all known risks and discomforts associated with study procedures, whether physical, psychological, economic or social (e.g., pain, stress, invasion of privacy, breach of confidentiality), noting the likelihood and degree of potential harm and measures taken to minimize risks and discomforts to participants. Question Title * 14. Do you plan to use any incentives to encourage participation? Yes No If yes, please describe. Question Title * 15. How will you de-identify the students in your reporting to ensure student confidentiality? Question Title * 16. We have students who are under 18 years of age. If your research involves students, what is your plan for removing underaged students from participants in this study? Question Title * 17. Will this information be used for a commercial endeavor? Yes No If yes, please describe the commercial nature of your research. Include how you will market goods and/or services to participants. Question Title * 18. Has your research been approved by an IRB at another institute? (If yes, please upload your IRB approval from your home institution). Yes No Question Title * 19. If applicable, upload a copy of IRB approval received from another institution. PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File If applicable, upload a copy of IRB approval received from another institution. Question Title * 20. After you have completed your research, how will you share your findings with DVC? Examples: Making a brief presentation to the Research, Planning, Evaluation Committee; sharing a brief summary report of the findings; providing a copy of the completed report. Next