ODU Child Development Center/Child Study Center and Oral Preschool Research Proposal
Form
Please complete the following research proposal form. After completion, you can submit it
electronically to sjudge@odu.edu
. Items marked with * are required.
I. Contact Information
Investigator(s)*: _________________________________________________________
Home Address*: _________________________________________________________
Home Phone (with area code)*: _____________________________________________
E-mail address*: _________________________________________________________
Business Address*: _______________________________________________________
Business Phone*: ________________________________________________________
II. University Affiliation
Investigator(s)
Undergraduate
Graduate
Faculty
Other – Please Specify
Department Affiliation: __________________________________________________
III. If research is being conducted under faculty supervision, please give name of project
advisor and department.
Project Advisor Name: __________________________________________________
Project Advisor Department: _____________________________________________
IV. Title of Research Project
Please write your title of research project: __________________________________
V. Project Date(s)
Please specify date(s) when research will be conducted: From _________ To __________
VI. Building or program in which research will be conducted:
Child Study Center
Child Development Center on 48
th
Street
Oral Preschool
VII. Classroom(s)/Age(s) with which research will be conducted:
_________________________________________________________
VIII. Research will satisfy:
Thesis
Dissertation
Other: Please specify
IX. What sources of funding (if any) are being used to support this research (for our record
keeping purposes only)?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
X. A brief description of the nature and purpose of the proposed study.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
XI. Has this study received Human Subjects clearance?
Yes
No
Where is a copy of this clearance on file? (Please specify)