Fillable REQUEST TO CONDUCT RESEARCH AT HAMPTON UNIVERSITY Hampton (Hampton University)

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REQUEST TO CONDUCT RESEARCH AT HAMPTON UNIVERSITY Hampton (Hampton University)

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HAMPTON UNIVERSITY
Hampton, Virginia 23668
Office of the Provost
REQUEST TO CONDUCT RESEARCH AT HAMPTON UNIVERSITY
Hampton University encourages responsible research that will be beneficial to the researcher, the
University, and the community at large by exploring new ideas, broadening understanding of a
particular field of study and seeking solutions to existing problems. However, the University
reserves the right to refuse requests that would interfere with the teaching/learning process,
threaten confidentiality of its constituents, or otherwise deemed inappropriate for an academic
environment.
Name: ___________________________________ Date: ________________________
Address: ______________________________ Phone Number: _______________
______________________________
Institutional Affiliation (If any):
Academic Status (If any):
____ Hampton University Faculty _____ Other
____ Hampton University Staff Member
____ Hampton University Alumni
1. Nature of the Research:
(Please attach research proposal)
2. The research involves human subjects ______ Yes _____ No
If yes, classify human subjects
3. List all institutional materials needed to conduct the study:
4. Research purpose (check more than one if necessary):
Class paper Engineering Research
M.A. Thesis Health Science Research
PhD Dissertation Liberal Arts Research
Business-Related Research Science Research
Educational Research Other
RESET
5. Publication plans (if any):
I have read and understand the guidelines for conducting research at Hampton University
and agree to abide by them.
Signature Date
FOR INTERNAL USE ONLY
Institutional Research Board (IRB) Researcher’s Dean or Unit Head
Approved ____ Not Approved ____ Approved ____ Not Approved ____
________________________________ ______________________________
Signature Signature
Researcher’s Chairperson or Unit Head Provost
Approved ____ Not Approved ____ Approved ____ Not Approved ____
________________________________ ______________________________
Signature Signature
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REQUEST TO CONDUCT RESEARCH AT HAMPTON UNIVERSITY Hampton (Hampton University)

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Completed 16 March 2021

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