"Research Acknowledgement Form - Institutional Review Board" - Florida

Research Acknowledgement Form - Institutional Review Board is a legal document that was released by the Florida Department of Juvenile Justice - a government authority operating within Florida.

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Download "Research Acknowledgement Form - Institutional Review Board" - Florida

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FLORIDA DEPARTMENT OF JUVENILE JUSTICE
Research Acknowledgement Form
Institutional Review Board
DATE:
TITLE OF PROPOSED RESEARCH:
NAME OF PRINCIPAL INVESTIGATOR/ RESEARCHER:
NAME OF ORGANIZATION/FACILITY:
NAME OF PROVIDER/AGENCY:
LOCATION ADDRESS:
CITY:
STATE:
ZIP CODE:
The following will be required of facility staff
:
(Check All That Apply)
Staff Time
Facility Resources
Other
Completion of Forms or Questionnaires
Audio-Visual Equipment
General Supervision
Computers
Interaction with Youth & Researcher
Internet Access
Mailing or Copying
Postage
Obtaining Outside Counselor for Youth
Printing or Copying
Parental Contact
Securing Monetary Incentives
Records Maintenance
Secure Storage of Research
Records Research
Other (list)
Youth Counseling
Other (list)
Additional comments, questions, support, concerns, etc., regarding the proposed research:
----------------------------------------------------------------------------------------------------------------------
By signing this Acknowledgement Form, I acknowledge that I am aware and approve of the
proposed research project as listed above and the required staff time / facility resources needed:
FACILITY ADMINISTRATOR/CONTACT PERSON:
SIGNATURE & TITLE:
E-MAIL:
PHONE:
☐ I do not wish to acknowledge the proposed research at this organization/facility
2737 Centerview Drive
Tallahassee, Florida 32399-3100
(850) 488-1850
http://www.djj.state.fl.us
The mission of the Department of Juvenile Justice is to increase public safety by reducing juvenile delinquency through effective
prevention, intervention, and treatment services that strengthen families and turn around the lives of troubled youth.
FLORIDA DEPARTMENT OF JUVENILE JUSTICE
Research Acknowledgement Form
Institutional Review Board
DATE:
TITLE OF PROPOSED RESEARCH:
NAME OF PRINCIPAL INVESTIGATOR/ RESEARCHER:
NAME OF ORGANIZATION/FACILITY:
NAME OF PROVIDER/AGENCY:
LOCATION ADDRESS:
CITY:
STATE:
ZIP CODE:
The following will be required of facility staff
:
(Check All That Apply)
Staff Time
Facility Resources
Other
Completion of Forms or Questionnaires
Audio-Visual Equipment
General Supervision
Computers
Interaction with Youth & Researcher
Internet Access
Mailing or Copying
Postage
Obtaining Outside Counselor for Youth
Printing or Copying
Parental Contact
Securing Monetary Incentives
Records Maintenance
Secure Storage of Research
Records Research
Other (list)
Youth Counseling
Other (list)
Additional comments, questions, support, concerns, etc., regarding the proposed research:
----------------------------------------------------------------------------------------------------------------------
By signing this Acknowledgement Form, I acknowledge that I am aware and approve of the
proposed research project as listed above and the required staff time / facility resources needed:
FACILITY ADMINISTRATOR/CONTACT PERSON:
SIGNATURE & TITLE:
E-MAIL:
PHONE:
☐ I do not wish to acknowledge the proposed research at this organization/facility
2737 Centerview Drive
Tallahassee, Florida 32399-3100
(850) 488-1850
http://www.djj.state.fl.us
The mission of the Department of Juvenile Justice is to increase public safety by reducing juvenile delinquency through effective
prevention, intervention, and treatment services that strengthen families and turn around the lives of troubled youth.