Please submit one copy of this completed form and all attached materials
electronically to:
Cleveland Community College
Research Proposal Form
Investigator Credentials:
Title of Proposal:
Research Question(s):
Purpose of the Study:
___ To fulfill requirements related to courses/degree program at a
___ Course project
___ Thesis (attach Proposal)
___ Dissertation (attach Proposal)
___ Other
___ As part of an externally funded project Funding Agency:
___ Other Please Describe:
Briefly answer the following questions:
1. Describe the subjects (include method of obtaining participation, criteria
for selection, age, payment/incentives, etc.):
2. Description of methodology (include variables to be measured and how
they will be measured). Include copies of survey(s) and/or interview
questions in attached materials:
3. Potential benefits of this study:
4. Are there any potential negative effects from this study? If yes, please
5. How will anonymity and confidentiality be controlled for:
6. Is deception involved or is there any aspect of the procedure that could
cause stress, discomfort or adverse reactions? Yes___
If yes, please explain.
7. What will you need from the College in order to complete this
research (data, list of names, etc.)?
8. Potential Benefits to CCC
9. How will informed consent be delivered (please attach informed consent
form if applicable)
Planning Council approved February 2, 2015.
Requirements for Informed Consent
Informed consent means the knowing consent of an individual without undue
inducement or any element of force, fraud, duress or any other form of constraint
or coercion.
Minimal information for informed consent:
1. General purpose of the research and a description of the
2. Statement that participation is voluntary and that the participant
may withdraw at any time without prejudice.
3. Explanation of whom to contact for answers to questions about the
4. If a signature is needed for the subjects, additional information
should be provided, including:
a. Duration of subject’s participation
b. Description of reasonably foreseeable risks
c. Description of benefits of the research
d. Disclosure of appropriate alternative procedures
e. Place for a signature and date
Research means a systematic investigation, including research development,
testing and evaluation, designed to develop or contribute to generalizable
knowledge. Activities, which meet this definition, constitute research for purposes
of this policy, whether or not they are conducted or supported under a program
which is considered research for other purposes. For example, some
demonstration and service programs may include research activities.
Minimal risk means that the probability and magnitude of harm or discomfort
anticipated in the research are not greater in and of themselves than those
ordinarily encountered in daily life or during the performance of routine physical
or psychological examinations or tests.
Planning Council approved February 2, 2015.