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Request for Research at McHenry County College

To request research at McHenry County College, attach PDFs of the following documents to this request form.

  1. Survey document or research tool
  2. Informed Consent document
  3. If representing an institution, attach the approved IRB form
  4. Other supporting material, if applicable

Please fill out the form completely. All fields are required.
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  5. Briefly describe the purpose of your study.
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  6. Summarize the available research (including published data) to provide justification for the study. Describe the significance of the research including potential benefit for individual subjects or society at large. Discuss how public health and social welfare might be enhanced.
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  7. Describe the research design and measurement tool (e.g. survey). Append all instruments (i.e. protocols, questionnaires, surveys, etc.). Include location of the study and describe the participant experience.
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  8. Describe the sample, sample size, sample characteristics (including age, race, or other demographics of interest), and how access to the sample will be obtained.
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  9. Describe any potential risks or benefits (emotional, physical, social, or political) to your participants.
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  10. Provide a detailed description of the proposed informed consent process with particular attention to the minimization of coercion. Provide a description of the consent procedures to be followed, including how, when, where, and by whom, informed consent will be obtained. Include an Informed Consent form if you will use one.
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  11. Confirmation Number: 123202203467
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