Request for Research at McHenry County College

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

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

Please fill out the form completely. All fields are required.

Is this an Undergraduate Research Scholar Program (URSP) research request? Please choose one

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Research Title Required
Name Required
Institution/Organization Required
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1. Objective(s) (1000 characters including space) Briefly describe the purpose of your study.

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2. Background and Rationale (1000 characters including space) 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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3. Procedures: Methodology and Measurement Tool (1000 characters including space) 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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4. Sample Characteristics (1000 characters including space) 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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5. Risks and Benefits (1000 characters including space) Describe any potential risks or benefits (emotional, physical, social, or political) to your participants.

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6. Informed Consent Procedure (2000 characters including space) 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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Confirmation Number: 42420241846925
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