ࡱ>     a jbjbA]A] "@+?+?b :::::::rzrzrz8z|&|8..\\\\71d,R-t:Y77YY::\\]Y:\:\N::::Y::" ƼrziL8s0p:srzrzAPPLICATION TO THE WALDEN UNIVERSITY INSTITUTIONAL REVIEW BOARD FOR APPROVAL TO CONDUCT RESEARCH INTRODUCTION WHAT IS IRB APPROVAL? The Institutional Review Board (IRB) consists of staff and faculty members from each of Walden's major research areas and is responsible for ensuring that all Walden University research complies with the universitys ethical standards as well as U.S. federal regulations. IRB approval is required before collection of any data, including pilot data. Approval is typically granted for a period of one year and is renewable. WHO SHOULD USE THIS IRB APPLICATION FORM? This application should be completed by all students and faculty members who are conducting research projects of any scope involving collection or analysis of data (whether from surveys, interviews, observation, student or employee work products, or records of any type). The only categories of research that do not need to be submitted for IRB approval are literature reviews, hypothetical research designs, and faculty projects that are completely independent of Walden resources, participants, and funding (including presentation and publication of results). Research projects conducted by fulltime employees of Walden or related organizations are also under the purview of the Walden IRB, as per federal regulations. Instead of completing this form, staff researchers should send an email inquiry to irb@waldenu.edu to initiate the IRB approval process for staff research. HOW LONG DOES IRB APPROVAL TAKE? This form takes 1-2 hours to complete, depending on the risk level of the study. The IRB review typically takes 2-3 weeks though low-risk studies can be reviewed in as little as 1 week if this form and the supporting materials are completely and accurately submitted. Directions to students: Students should allow a reasonable amount of time for their supervising faculty member to review and approve the application. It is the students responsibility to make sure that the faculty-approved IRB application and all supporting materials are submitted to irb@waldenu.edu. It is expected that dissertation/thesis students will review IRB requirements as they are writing the proposal and will submit the IRB application just before or after proposal approval. Ph.D. candidates may submit their IRB materials at any time but the formal IRB review cannot be scheduled until the proposal is fully approved by the committee and program chair. Directions to faculty members: Please submit this IRB form and all supporting materials to irb@waldenu.edu. No prior approval is necessary; the IRB will seek approval on your behalf from the appropriate University leadership. Please email irb@waldenu.edu if you have any questions. OVERVIEW OF REQUIREMENTS OF THIS IRB APPLICATION General Description of the Proposed Research - Translate your research question(s) into lay language. - Provide specific descriptions of the tasks the participants will be asked to complete. Data Collection Tools - Submit all documents related to data collection including surveys, interview questions, permission to use unpublished assessments, etc. - Provide appropriate permissions to use any published unpublished data collection tools. Description of the Research Participants - Describe the study population, particularly inclusion and exclusion criteria. - If applicable, complete extra sections relevant to working with children, facility residents, or other protected populations. Community Research Stakeholders and Partners - Submit a letter of cooperation from any organization or community partner who will be involved in identifying potential participants or collecting data. - Describe your plan for sharing your research results with relevant stakeholders. Potential Risks and Benefits - Describe anticipated risks and benefits of study participation. - Make provisions to minimize risks to research participants and document those procedures in this online application. Data Confidentiality - Describe procedures to maintain confidentiality. - If data includes personal identifiers, submit signed certificates of confidentiality for everyone who has access to the data (except faculty members). - If applicable, complete extra sections relevant to protected health information. Potential Conflicts of Interest - Disclose and manage potential conflicts of interest. Informed Consent - Make provisions to obtain informed consent from all study participants and the appropriate parents, guardians, or caregivers. Expedited Review Criteria -Indicate whether your study is low risk and thus, qualifies for expedited review. Final Checklist and Electronic Signatures -Students must obtain faculty approval (via electronic signature) before submitting this form to irb@waldenu.edu. INSTRUCTIONS This form MUST be completed and submitted via email. If you have questions as you are completing the form, please contact irb@waldenu.edu. PROJECT INFORMATION 1. Researcher's last name  FORMTEXT     BOWE  2. Researcher's first name  FORMTEXT ANDREA3. Researcher's email address  FORMTEXT spiritualun2002@yahoo.com & scitechgrantconsultation@yahoo.com4. Project title  FORMTEXT       5. If researcher is a student, please provide the name of the committee chair or other faculty member supervising this research.  FORMTEXT Amie Beckett6. Email address of committee chair or supervising faculty member  FORMTEXT abeckett@waldenu.edu7. Walden program affiliation(s) of researcher:  FORMCHECKBOX  Education  FORMCHECKBOX  Engineering and Applied Science  FORMCHECKBOX  Health and Human Services  FORMCHECKBOX  Management  FORMCHECKBOX  Nursing  FORMCHECKBOX  Psychology  FORMCHECKBOX  Public Policy  FORMCHECKBOX  Social Work 8. Type of research:  FORMCHECKBOX  Doctoral Dissertation  FORMCHECKBOX  Doctoral KAM study  FORMCHECKBOX  Doctoral Pilot Study (i.e., through ED 8458/8468)  FORMCHECKBOX  Ed.D. Doctoral Study  FORMCHECKBOX  Masters Thesis  FORMCHECKBOX  Faculty Research  FORMCHECKBOX  Research for a course (please specify course number)  FORMTEXT        FORMCHECKBOX  Other  FORMTEXT        GENERAL DESCRIPTION OF THE PROPOSED RESEARCH 9. Please check all the research methods that will be used in this study.  FORMCHECKBOX  Survey or assessment completed by participant  FORMCHECKBOX  Interview  FORMCHECKBOX  Assessment of cognitive or physical performance  FORMCHECKBOX  Assessment of product or service effectiveness  FORMCHECKBOX  Assessment of program outcomes  FORMCHECKBOX  Assessment of treatment outcomes  FORMCHECKBOX  Analysis of student work products  FORMCHECKBOX  Analysis of existing public records  FORMCHECKBOX  Analysis of existing privately held records  FORMCHECKBOX  Observation of people in public places  FORMCHECKBOX  Observational study that involves manipulation of the participants environment  FORMCHECKBOX  Collection of physical specimens (e.g. blood, saliva)  FORMCHECKBOX  Use of animals  FORMCHECKBOX  Experimental groups (i.e., between-subject design)  FORMCHECKBOX  Experimental conditions, assessments, or tasks (i.e., within-subjects design)  FORMCHECKBOX  Other (please specify)  FORMTEXT       10. Using lay terms please state your research question. Note: Please do not use jargon or acronyms, as this application needs to be comprehensible to IRB reviewers outside of your field.  FORMTEXT Will only one experience in a Design by TEAMS methdology Workshop increase self-esteem and meta-cognitive thinking skills in the participant population. This population will be given a short survey and a short computer-generated simulation of the Methodology and another short survey, ten questions or less, after the workshop experience. Only voluntary and anonymous research and feedback will be generated, with statistical analysis and numbers available immediately online. 11. Quantitative researchers: Please list each variable of interest and briefly explain how it will be assessed. Qualitative researchers: Please describe the phenomenon of interest and how it will be recorded. Note: The following section will ask for more detailed information about your data collection tools.  FORMTEXT This is a mixed method study. The quantitative and qualitative variables are choice and feedback and how they may affect both self-esteem and subsequent development over time in TEAMS Methodolgy of metacognitive faculties in the digital age, especially for the M or Multi-tasking generation.. 12. Please briefly describe the analyses planned. Note: In other words, please describe which statistical or analytical methods you will use to reveal expected relationships, differences, or patterns.  FORMTEXT The computer program that gives the anonymity will also be geared to analyze the results in several different statistical formats, including rubrics that are self-designed in the TEAMS Process on a scale of one to ten, or poor to rich. 13. Please briefly describe the research procedures, along with the duration, location, and communication format for each. You probably will not need to use all the rows provided but you must describe any of the following that apply to your study: examination of records, initial contact, informed consent procedures, surveys, interviews, assessments, observations, intervention/treatment, review of interview transcripts, and dissemination of studys results to participants and stakeholders. If there are more than 10 steps, then you may email an attachment (e.g., your proposals method section) to irb@waldenu.edu. Brief descriptionDurationExact LocationCommunication Format (e.g., email, phone, in person, internet, etc.)Step 1 Typically initial contact  FORMTEXT Computer Program will generate a number for each participant and team, and the post survey will include the role on the team by the addition of a letter. FORMTEXT 7 minutes to one hour FORMTEXT Home, school, or computer interface FORMTEXT internet or intranetStep 2 Typically consent  FORMTEXT Graphic cues will indicate agreement and informed consent for non-literate users. FORMTEXT Check the box FORMTEXT computer FORMTEXT internet or interactive simulation game on cd or dvdStep 3  FORMTEXT Short yes/no checked box survey with graphic cues and mentors FORMTEXT one to two minutes FORMTEXT computer or hands-on workshops FORMTEXT in person or computer avatarStep 4 FORMTEXT enter design by TEAMS, choose a Project, choose a role FORMTEXT 1 minute FORMTEXT computer FORMTEXT simStep 5 FORMTEXT design a rubric to show you know FORMTEXT 5 minutes FORMTEXT computer FORMTEXT simStep 6 FORMTEXT write a poem or dance a reel, even a rap song is a good deal FORMTEXT 10 minutes FORMTEXT computer FORMTEXT simStep 7 FORMTEXT experience the workshop FORMTEXT 10 minutes at most FORMTEXT computer FORMTEXT simStep 8 FORMTEXT take a short survey again to try to see if attitudes of self-esteem and critical thinking have improved FORMTEXT one to two minutes FORMTEXT computer FORMTEXT simStep 9 FORMTEXT sign out  FORMTEXT 30 seconds FORMTEXT computer FORMTEXT simStep 10  FORMTEXT get diploma with your unique number for voluntary feedback online in three to six months for being one of the first to try the systems science approach to learning FORMTEXT 1 minute FORMTEXT computer FORMTEXT printer DATA COLLECTION TOOLS In order to approve your study, the IRB needs to review the text of each data collection tool (e.g., surveys, assessments, interview questions, etc.). The final checklist will direct you to send your data collection tools and any relevant permissions at the same time you submit this IRB form. Note: If any further changes are made to the data collection tools after they have been IRB-approved, you must submit those changes for IRB approval. 14. Please indicate the sources of each of your data collection tools. I created the following data collection tools myself:  FORMTEXT computer simluation I have purchased legal copies of the following data collection tools:  FORMTEXT       The following data collection tools are not published and I will be sending the author s permission at the same time I submit this form:  FORMTEXT       15. If any of your data collection instruments were created by someone else, please provide the full citation for each instrument's source in APA format.  FORMTEXT        DESCRIPTION OF THE RESEARCH PARTICIPANTS 16. Provide the target number of participants.  FORMTEXT 100+ 17. Describe the criteria for inclusion and exclusion of participants in this study (such as relevant experiences, age, gender, health conditions, etc). Your inclusion criteria should define all critical characteristics of your sample. Once youve defined inclusion criteria, if you have no further limitations on who can participate, just indicate none under exclusion criteria. Inclusion criteria:  FORMTEXT only those willing to participate, as choice is more important in this research Exclusion criteria:  FORMTEXT none 18. Please indicate whether each of the following vulnerable or protected populations is targeted, included, or excluded from your study. Targeted Included (But not targeted)Excluded Pregnant Women FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Children FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Prisoners FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Residents of Any Facility (Nursing Home, Assisted Living, Group Home) FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Mentally/Emotionally Disabled Individuals FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Non-English Speakers FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Elderly Individuals (65+) FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Traumatized Individuals FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Economically Disadvantaged Individuals FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Clients or Potential Clients of the Researcher FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Other  FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  None of the above FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  ADDITIONAL ISSUES TO ADDRESS WHEN PARTICIPANTS INCLUDE RESIDENTS OF A FACILITY 19. Will your sample include residents of any facility (including prisons, juvenile detention centers, nursing homes, mental health facilities, rehabilitation facilities, etc?)  FORMCHECKBOX  Yes ! Please complete question 20.  FORMCHECKBOX  No ! Please skip ahead to question 21.  20. The use of facility residents as participants requires that the investigator comply with the additional protections provided in the relevant code of federal regulations (link provided on IRB page of the Walden Research Center website). A. Will this study examine the possible causes, effects, or processes of incarceration and/or criminal behavior?  FORMCHECKBOX  Yes  FORMCHECKBOX  No B. Will this study examine the facility as an institutional structure?  FORMCHECKBOX  Yes  FORMCHECKBOX  No C. Will this study specifically examine the experience of living in that particular type of facility?  FORMCHECKBOX  Yes  FORMCHECKBOX  No D. Will this study examine a condition(s) particularly affecting these types of facility residents?  FORMCHECKBOX  Yes  FORMCHECKBOX  No E. Will this study examine a procedure, innovative or accepted, that will have the intent or reasonable probability of improving the health or well being of the participants?  FORMCHECKBOX  Yes, and residents will be assigned to groups by  FORMTEXT        FORMCHECKBOX  No  ADDITIONAL ISSUES TO ADDRESS WHEN PARTICIPANTS INCLUDE PROTECTED POPULATIONS 21. Will your sample include any members of vulnerable or protected populations listed in question 18?  FORMCHECKBOX  Yes ! Please complete questions 22-23.  FORMCHECKBOX  No ! Please skip ahead to question 24.  22.Please briefly justify the inclusion of each protected population. FORMTEXT       23.If competency to provide consent could possibly be an issue, describe how competency will be determined and your plan for obtaining consent. If not applicable, please indicate NA.  FORMTEXT A check box will indicate consent, but parental or teacher control will be needed if young children wish to be included in the participant population. Since all research will be anonymous and independent of age factors, this couldbe a cause for concern. ADDITIONAL ISSUES TO ADDRESS WHEN PARTICIPANTS INCLUDE CHILDREN 24. Will your sample include individuals less than 18 years of age?  FORMCHECKBOX  Yes ! Please complete questions 25-26.  FORMCHECKBOX  No ! Please skip ahead to question 27.  25. If this study proposes to include minors, this inclusion must meet one of the following criteria for risk/benefit assessment, according to the federal regulations (link provided on IRB page of the Walden Research Center website). Check the one appropriate box:  FORMCHECKBOX  Minimal risk  FORMCHECKBOX  Greater than minimal risk, but holds prospect of direct benefit to participants  FORMCHECKBOX  Greater than minimal risk, no prospect of direct benefit to participants, but likely to yield generalizable knowledge about the participants disorder or condition. 26.Please explain how the criterion in question 25 is met for this study.  FORMTEXT All children who cannot read should have an interface with an avatar who will lead them through the process of granting consent, and those giving the workshop should also be made aware of the need to encourage choice and give adequate feedback to show how the research will preserve anonymity, thus minimizing risk. COMMUNITY RESEARCH STAKEHOLDERS AND PARTNERS Stakeholders include a) anyone who contributed significantly to the creation of the data or records as well as b) any leaders or community members who would potentially be impacted by the research results. Community partners include any schools, clinics, businesses, non-profits, government entities, residential facilities, or other organizations who are involved in your research project. The final checklist will direct you to email or fax your community partners letters of cooperation at the same time you submit this IRB form. 27. Please identify all community stakeholders who should hear about your research results and indicate your specific plan for disseminating your results in an appropriate format. Note: Walden students are required to disseminate their research results in a responsible, respectful manner and are encouraged to develop this dissemination plan in consultation with the relevant community partner(s). Sometimes it is appropriate to provide a debriefing session/handout to individual participants immediately after data collection in addition to a general stakeholders debriefing after data analysis.  FORMTEXT All research will be made available free online.28. Please specify the name(s) and roles of any community partner organizations you propose to involve in identifying potential participants or collecting data. Also please identify the individual who will be signing the letter of cooperation. (See IRB section of the Walden website for a sample letter). Note: If you have no community research partner, that means you are solely relying on public records to recruit participants and collect data.  FORMTEXT      29. Please briefly describe how you chose each of the partners listed above.  FORMTEXT       POTENTIAL RISKS AND BENEFITS 30. Please conservatively estimate the potential level of risk to participants and stakeholders relevant to each of the following categories. Please note: Minimal risk is acceptable but must be identified upfront. NoneMinimalModerateSubstantial A. Unintended disclosure of confidential information (such as educational or medical records) FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  B. Psychological stress greater than what one would experience in daily life (e.g., materials or topics that could be considered sensitive, offensive, threatening, or degrading) FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  C. Attention to personal information that is irrelevant to the study (i.e., related to sexual practices, family history, substance use, illegal behavior, medical or mental health) FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  D. Unwanted solicitation, intrusion, or observation in public places  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  E. Unwanted intrusion of privacy of others not involved in study (e.g. participants family).  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  F. Social or economic loss (i.e., collecting data that could be damaging to any participants or stakeholders financial standing, employability or reputation) FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  G. Perceived coercion to participate due to any existing or expected relationship between the participant and the researcher (or any entity that the researcher might be perceived to represent) FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  H. Misunderstanding as a result of experimental deception (such as placebo treatment or use of confederate research assistants posing as someone else) FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  I. Minor negative effects on participants or stakeholders health (no risk of serious injury) FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  J. Major negative effects on participants or stakeholders health (risk of serious injury) FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  31. Explain what steps will be taken to minimize risks and to protect participants and stakeholders welfare. If the research will include protected populations, please identify each group and answer this question for each group.  FORMTEXT Anonymity will be guaranteed by never taking anyone's name or data, except that generated by the TEAMS themselves.32. Please describe the anticipated benefits of this research for individual participants.  FORMTEXT The use of choice and feedback to increase meta-cognitive thinking skills and self-esteem will increase joy in learning for participants.33. Describe the anticipated benefits of this research for society.  FORMTEXT The use of the simple DESIGN by TEAMS as a new paradigm for learning and teaching will become apparent as the research piles up, helping to heal and become whole beings for all society. DATA CONFIDENTIALITY 34. In what format will you store the data? (paper, electronic media, video, audio)  FORMTEXT Computer35. Where will you store the data?  FORMTEXT Computer Programs36. How long will you keep the data? (Five years is the minimum requirement.)  FORMTEXT 10 years37. Describe what security provisions will be taken to protect this data (e.g., password protection, locks).  FORMTEXT no names will ever be associated with the data, only a number that the participant is given to allow voluntary online feedback for longitudinal research38. Will you record any direct identifiers, names, social security numbers, addresses, telephone numbers, etc?  FORMCHECKBOX  No  FORMCHECKBOX  Yes, and the following coding system will be used to protect against disclosure of these identifiers:  FORMTEXT       39. Will you retain a link between study code numbers and direct identifiers after the data collection is complete?  FORMCHECKBOX  No  FORMCHECKBOX  Yes, it is necessary because  FORMTEXT        FORMCHECKBOX  Not applicable to my research proposal 40. Will you provide an identifier or potentially identifying link to anyone else besides yourself?  FORMCHECKBOX  No  FORMCHECKBOX  Yes, it is necessary because  FORMTEXT        FORMCHECKBOX  Not applicable to my research proposal 41. Explain who will approach potential participants to take part in the research study and what will be done to protect individuals privacy in this process.  FORMTEXT Computer and internet ads42. Please list all individuals who will have access to the data (including research assistants, transcribers, statisticians, etc). If you are a student, the IRB assumes your supervising faculty members will have access to the data, so you do not need to list them.  FORMTEXT every participant and stakeholder 43. To ensure data confidentiality among your research colleagues, you will either need to obtain a signed confidentiality agreement for each person you listed for Question 42 or de-identify the data (by removing all identifying links) before anyone else has access to it. Please visit the Walden Research Center website to download a sample confidentiality agreement. Either handwritten or electronic signatures will be sufficient. You will be directed to send the IRB your signed confidentiality forms at the same time you submit this IRB form. Please check all that apply.  FORMCHECKBOX  I will be emailing the signed confidentiality agreement(s) to irb@waldenu.edu.  FORMCHECKBOX  I will be faxing the signed confidentiality agreement(s) to (626) 605-0472.  FORMCHECKBOX  Not applicable because I am the only one who will have access to the raw data.  FORMCHECKBOX  Not applicable because the accessible data is anonymous or de-identified. 44. If the data collected contains information about illegal behavior, it might be appropriate for you to obtain a Federal Certificate of Confidentiality, which can shield your data from subpoena. The IRB page of Walden Research Center website provides a link to NIHs online Kiosk, which provides more information. Will you obtain a Federal Certificate of Confidentiality for this research?  FORMCHECKBOX  Yes. I will be submitting a copy at the same time I submit this form to  HYPERLINK "mailto:irb@waldenu.edu" irb@waldenu.edu  FORMCHECKBOX  No. My research involves reports of illegal behavior but I have opted not to seek a Federal Certificate of Confidentiality.  FORMCHECKBOX  No. My research does not ask participants to report any type of illegal behavior.  ADDITIONAL ISSUES TO ADDRESS WHEN THE RESEARCH INVOLVES PROTECTED HEALTH INFORMATION 45. As part of this study, the researcher(s) will:  FORMCHECKBOX  Collect protected health information* from participants ! Please complete question 46.  FORMCHECKBOX  Have access to protected health information* in the participants records ! Please complete question 46.  FORMCHECKBOX  None of the above ! Please skip to question 47.  *Protected Health Information (PHI) is defined under HIPAA (Health Insurance Portability and Accountability Act of 1996) as health information transmitted or maintained in any form or medium that: A. identifies or could be used to identify an individual; B. is created or received by a healthcare provider, health plan, employer or healthcare clearinghouse; and C. relates to the past, present or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present or future payment for the provision of healthcare to an individual. For more information on protected health information, please visit the IRB page of the Walden Research Center website. 46. To use PHI in research you must have approval through one of the following methods: A. An authorization signed by the research participant that meets HIPAA requirements; or B. Use of a limited data set under a data use agreement. Check below to indicate which method of approval you will use.  FORMCHECKBOX  A. Research participants in this study will sign an Authorization to Use or Disclose PHI for Research Purposes form. If the study includes multiple activities (e.g., clinical trial or collection and storage of PHI in a central repository), then two authorization forms must be submitted for review. You may download a sample authorization form at the Research Center website, fill in the required information, and fax to (626) 605-0472.  FORMCHECKBOX  B. I will access a limited data set by signing a data use agreement with the party that releases the PHI. A limited data set must have all possible identifiers removed from the data. It is the responsibility of the researcher and the party releasing the PHI to have in place and maintain a copy of a data use agreement which meets HIPAA requirements. Use the template data use agreement and fill in the required information. A copy of the signed Data Use agreement must be submitted for review.  POTENTIAL CONFLICTS OF INTEREST 47. Do any of the researchers have a potential conflict of interest associated with this study? In other words, is it possible that the professional positions or financial situations of the researchers or their families be directly impacted by the design, conduct, or results of this research?  FORMCHECKBOX  No  FORMCHECKBOX  Yes, and the conflict of interest is being managed by  FORMTEXT       48. Most researchers have multiple roles in their professional environment. At the time of study recruitment, are the potential study participants aware of any of the researchers other professional or public roles? (Such as teacher, therapist, community leader, etc.?)  FORMCHECKBOX  No  FORMCHECKBOX  Yes, at the time of recruitment some of the participants are aware of the researchers  FORMTEXT       role, and the following measures will be taken to distinguish his/her research role and minimize perceived coercion to participate:  FORMTEXT       49. Will the researcher give participants or stakeholders any gifts, payments, compensation, reimbursement, free services, or extra credit?  FORMCHECKBOX  No  FORMCHECKBOX  Yes. More information is provided below. What compensation will be given?  FORMTEXT       At what point during the research will the compensation be given?  FORMTEXT       Under what conditions will the compensation be given? (i.e., how will compensation for withdrawn participants be handled?)  FORMTEXT        INFORMED CONSENT The final checklist will direct you to email your consent/assent forms to irb@waldenu.edu at the same time you submit this IRB form. Your application is not considered complete until they are received. 50. Federal regulations require that the informed consent procedures disclose each of the elements in the checklist below and that consent be documented (usually by asking the participants to sign the consent form listing all of the disclosures). Anonymous surveys rely on implicit endorsement rather than obtaining a signed endorsement (i.e., the participant indicates willingness to participate by completing the survey). A consent form template can be downloaded from the IRB section of the Walden Research Center website. Researchers are not required to use the Walden template verbatim, but it does include each of the required elements in the checklist below. When participants are between ages 7 and 18, researchers must obtain parental consent in addition to asking the children to review and sign an age-appropriate assent form. You may link to the relevant regulations from the IRB page of the Walden Research Center website.  Please affirm that your consent form(s) contain each of the following required elements.YESNONA Statement that the study involves research FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Statement of why subject was selected FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Disclosure of the identity and all relevant roles of researcher (e.g., Ph.D. candidate, part-time faculty member, facility owner) FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  An understandable explanation of research purpose FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  An understandable description of procedures FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Expected duration of subject's participation FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Statement that participation is voluntary FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Statement that refusing or discontinuing participation involves no penalty FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Description of reasonably foreseeable risks or discomforts FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Description of anticipated benefits to subjects or others FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Information on compensation for participation FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Description of how confidentiality will be maintained FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Whom to contact with questions about the research FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Statement that subject may keep a copy of the informed consent form FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  All potential conflicts of interest are disclosed  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Consent process and documentation are in language understandable to the participant FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  There is no language that asks the subject to waive his/her legal rights FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  If appropriate, indicates that a procedure is experimental (i.e., not a standard Rx) FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  If appropriate, disclosure of alternative procedures/treatment  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  If appropriate, additional costs to subject resulting from research participation FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  EXPEDITED REVIEW CRITERIA 51. Your study qualifies for expedited review if all research activities therein fall under one or more of the following minimal risk categories. If the IRB chair agrees that your study is limited to the following categories, your IRB application will be reviewed by a single member of the Institutional Review Board rather than the full IRB (and this is typically 1-3 weeks faster than full review). If applicable, please indicate which expedited review categories apply to this research.  FORMCHECKBOX  Educational Research: Research conducted in established or commonly accepted educational settings, involving normal educational practices, such as (a) research on regular and special education instructional strategies, or (b) research on the effectiveness of or the comparison among instructional techniques, curricula, or classroom management methods.  FORMCHECKBOX  Performance and Opinion Research: Research involving the use of educational tests (cognitive, diagnostic, aptitude, achievement), survey procedures, interview procedures or observation of public behavior, unless: (a) information obtained is recorded in such a manner that human participants can be identified, directly or through identifiers linked to the participants; and (b) any disclosure of the human participants' responses outside the research could reasonably place the participants at risk of criminal or civil liability or be damaging to the participants' financial standing, employability, or reputation. Potentially upsetting or offensive content is not eligible for expedited review.  FORMCHECKBOX  Archival Research: Research involving the collection or study of existing data, documents, records, pathological specimens, or diagnostic specimens, if these sources are publicly available or if the information is recorded by the investigator in such a manner that participants cannot be identified, directly or through identifiers linked to the participants.  FORMCHECKBOX  Evaluation of Public Programs: Evaluation and demonstration projects that are conducted by or subject to the approval of Department or Agency heads, and which are designed to study, evaluate, or otherwise examine: (a) Public benefit or service programs; (b) procedures for obtaining benefits or services under those programs; (c) possible changes in or alternatives to those programs or procedures; or (d) possible changes in methods or levels of payment for benefits or services under those programs.  FORMCHECKBOX  Expedited review is not appropriate for my research.  FINAL IRB CHECKLIST 52. Please indicate below which method you are using to send each of your supporting documents. We ask that you send these supporting documents to the IRB at the same time you submit this application. Students must obtain their supervising faculty members approval on the last page before submitting any materials to the IRB. Emailed to irb@waldenu.eduFaxed to (626) 605-0472Not applicable to my studyData collection tools (e.g., surveys, interviews, assessments, etc.) FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Letters of permission from authors of data collection tools FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Letters of cooperation from community partners FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Invitation to participate in research (e.g., letter, flier, phone script, ad, etc.) FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Signed confidentiality agreements  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Federal certificate of confidentiality (to shield data from subpoena) FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Consent/assent forms  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Please maintain a copy of this completed application for your records. Once the IRB application and all supporting documents have been received, the Research Coordinator will email the researcher and any relevant faculty supervisors to confirm that the IRB application is complete. At this time, the Research Coordinator will also notify the researcher of the expected IRB review date for the proposal. The review date will be scheduled no later than three weeks after your completion of this application. In the case of Ph.D. candidates, the review date will be scheduled no later than three weeks after both A) the application is complete and B) the proposal is fully approved. Notice of outcome of the IRB review will be emailed to the researcher and any supervising faculty members within one week of the review. Please be aware that the IRB committee might require revisions or additions to your application before approval can be granted. Neither pilot nor research data may be collected before notification of IRB approval. Students collecting data without approval risk expulsion and invalidation of data. The IRB will make every effort to help researchers move forward in a timely manner. Please contact irb@waldenu.edu if you have any questions. RESEARCHER ELECTRONIC SIGNATURE 53. By checking each of these boxes and providing my email address below as an authentication, I am providing an electronic signature certifying that each of the statements below is true.  FORMCHECKBOX  The information provided in this application form is correct.  FORMCHECKBOX  I agree to conduct this and all future IRB correspondence electronically, via email/fax.    FORMCHECKBOX  I, the researcher, will request IRB approval before making any substantive modification to this study using the Request for Change in Procedures Form found at the Walden Research Center website.  FORMCHECKBOX  I, the researcher, will report any unexpected or otherwise significant adverse events and general problems within one week using the Adverse Event Reporting Form found at the Walden Research Center website.  FORMCHECKBOX  Neither recruitment nor data collection will be initiated until final IRB approval is granted.  FORMCHECKBOX  I understand that this research, once approved, is subject to continuing review and approval by the Committee Chair and the IRB.  FORMCHECKBOX  I, the researcher, will maintain complete and accurate records of all research activities.  FORMCHECKBOX  I understand that if any of the conditions above are not met, this research could be suspended and/or not recognized by Walden University.  Researcher email address (provides authentication for electronic signature and thus must match email address on file with Walden University)  FORMTEXT spiritualun2002@yahoo.com Research Center Policy on Electronic Signatures Waldens Research Center manages dissertation, thesis, and IRB processes in a nearly paperless environment, which requires reliance on verifiable electronic signatures, as regulated by the Uniform Electronic Transactions Act. Legally, an "electronic signature" can be the persons typed name, their email address, or any other identifying marker. An electronic signature is just as valid as a written signature as long as both parties have agreed to conduct the transaction electronically. The Research Coordinator will verify any electronic signatures that do not originate from a password-protected source (i.e., an email address officially on file with Walden). Supervising Faculty Member Electronic Signature 54. As the faculty member supervising this research, I assume responsibility for ensuring that the student complies with University and federal regulations regarding the use of human participants in research. By checking each of these boxes and providing my email address below as an authentication, I am providing an electronic signature certifying that each of the statements below is true.  FORMCHECKBOX  I affirm that this research proposal is in keeping with the standards set by the University.  FORMCHECKBOX  I affirm that the researcher has met all academic program requirements for review and approval of this research.  FORMCHECKBOX  I will ensure that the researcher properly requests any protocol changes using the Request for Change in Procedures Form found at the Walden Research Center website.  FORMCHECKBOX  I will ensure that the student promptly reports any unexpected or otherwise significant adverse events and general problems within 1 week using the Adverse Event Reporting Form found at the Walden Research Center website.  FORMCHECKBOX  I will report any noncompliance on the part of the researcher by emailing notification to irb@waldenu.edu.  Faculty member email address (provides authentication for electronic signature and thus must match email address on file with Walden University):  FORMTEXT       Research Center Policy on Electronic Signatures Walden s Research Center manages dissertation, thesis, and IRB processes in a nearly paperless environment, which requires reliance on verifiable electronic signatures, as regulated by the  Uniform Electronic Transactions Act Error! Bookmark not defined.. Legally, an "electronic signature" can be the persons typed name, their email address, or any other identifying marker. 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