ࡱ> Z\Y pAbjbj 5Pee 7x x HHHHH\\\84\"l x:H!!!!!!!,k$'!]H!HH4U"^HH!!!Z!o*&!!k"0".!,''Z!HZ!\!!"'x :   Appendix A Use of School Classroom as a Performance Site for Human Subject Research Office of Research and Sponsored Projects (ORSP) 91Porn 5500 N. St. Louis Avenue Chicago, IL 60625-4699 Phone: 773.442.4670 Fax: 773-442-4673  Introduction NEIU researchers planning to conduct human subject research in the context of a school classroom must complete this form. Are there any schools where this research will be conducted that are not specifically listed in the application form?  FORMCHECKBOX  Yes  FORMCHECKBOX  No (if yes, please list below, including school district and specific school names).School District: FORMTEXT      School Name: FORMTEXT      School District: FORMTEXT      School Name: FORMTEXT      Does the school district have its own Institutional Review Board? FORMCHECKBOX Yes(Include documentation of approval). FORMCHECKBOX No(Include documentation of the approval of the principal on school letterhead).Who is/are the subject(s) of the research? FORMCHECKBOX Teacher(Include teachers consent document) FORMCHECKBOX Student(Include parental permission and student assent forms). FORMCHECKBOX Administrative personnel(Include consent document and describe personnel below):Administrative personnel:  FORMTEXT      Clarify if students can decline to participate, and if so explain the alternatives to participation and the consequences of withdrawing from the study, if any:  FORMTEXT      Describe in detail the activity(ies) planned for non-participants Note: If the research will occur in the classroom during class time, please describe alternative activity planned for students who do not participate, including a description of supervisory provisions:  FORMTEXT       Clarify if the objectives of the   VW^anx      " $ & 2 4 P ͼͼ޼޵vcvv%jh P&CJOJQJU^Jjh P&CJOJQJU^Jh P&CJOJQJ^Jh h@hCJOJQJ^JaJhCJOJQJ^JaJ h@h h(5CJOJQJ\^JaJ h5CJOJQJ\^JaJ&h@h5CJOJQJ\^JaJ h P&CJh h P&$VW  $$&@#$/Ifa$gd$d$Ifa$gd $$Ifa$gd$<$Ifa$gdd$&@#$/If$If     |xrgY & Fxx$If  h$If$Ifkd$$Ifl0~( 6@0 )62s4 laP R T  & ( < > @ J L N h j ~      vq h P&5h P&5OJQJ\^Jjh P&Uj7h P&Ujh P&Ujh P&UmHnHujh P&Uh P&jh P&U h P&5\h P&CJOJQJ^Jjh P&CJOJQJU^J%jh P&CJOJQJU^J&  & N h  & F$If  & F8$If^8bkd$$Ifl|D%(0(64 la  RB666  & Fx$If & F8x$If^8kd$$Ifl\|D%   0(62s222s4 la RF  & Fx$Ifkd$$Ifl\|D%   0(62s222s4 la  <$If $<$Ifa$bkdO$$IflF|D%(0(64 la   < > @  !/01_`aopq45?tf\h P&OJQJ^Jjh P&OJQJU^J'jm h P&5OJQJU\^J'j h P&5OJQJU\^J'j h P&5OJQJU\^J h P&5'jch P&5OJQJU\^Jh P&'jh P&5OJQJU\^Jh P&5OJQJ\^J!jh P&5OJQJU\^J#  B H nc[[x$If $x$Ifa$kdS$$IflaF|D%T1C 0(6    22s4 la nb  & Fx$Ifkd$$IflF|D%T1C 0(6    22s4 la 2:_<$If $<$Ifa$bkd $$Ifl|D%(0(64 la_`rzwldd<$If $<$Ifa$kd $$IflF| D%T 0(6    4 lawldd<$If $<$Ifa$kdo $$IflZF| D%T 0(6    4 lawi_ xx$Ifxx$If^kd $$IflPF| D%T 0(6    4 la?@  PRfhjtvxz:==========>?@?࿻ౠ౛z౿xg౿!j!h P&OJQJU^JU!jh P&OJQJU^Jh P&56OJQJ\]^J h P&5!jh P&OJQJU^Jh P&OJQJ^Jh P&h P&5OJQJ\^J&jh P&OJQJU^JmHnHujh P&OJQJU^J!jh P&OJQJU^J(Px~r 8x$If^8  & Fx$IfukdW$$IflE0|D%Tt"0(64 laxzy x$If^ 8x$If^8  & Fx$Ifbkd$$Ifl |D%(0(64 la===y x$If^ 8x$If^8  & Fx$Ifbkd$$Ifl |D%(0(64 la research are consistent with the course curriculum. If the principal investigator is NOT also the classroom instructor, please provide a copy of the syllabus and a letter of support from the classroom instructor indicating that the goals of the research and the classroom are consistent. If the principal investigator is also the classroom instructor, please submit a copy of the syllabus and an explanation of how this research fits in with the educational goals of the classroom:  FORMTEXT       Describe mechanisms that will be put in place to minimize loss of classroom time (remember, generally students are not in a class in order to be a research subject):  FORMTEXT       If participation requires removal of students from the classroom, please carefully explain how this will occur, including an explanation for avoiding stigmatization of the subject.  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