Project Summary



The purpose of this form is to support a determination whether your activities constitute human subjects research. Based on the information you provide, the HSRC may request that you provide additional information or complete a full application. After you have completed this from, return it to cara.stevens@ for review.

Project Title:

Include the name, degrees, and contact information of the individual who will be responsible for conducting the research or activities.

Principle Investigator:

A. Provide a brief non-technical description of the activities.

I. Overview:

II. Study Aims:

III. Study Procedures:

B. Generalizable knowledge might include information presented to a broader audience or published with the intent of drawing scientific conclusions or increasing the body of scientific knowledge. Please indicate any of the following to which the results of the proposed activity will be applied.

| |Note: to check a box, right click on the box then select properties; select checked under default value. |Yes |No |

|1. |Part of a graded assignment for educational purposes only? | | |

|2. |Part of a dissertation or thesis? | | |

|3. |Part of a submission to a journal for potential publication? | | |

|4. |Part of a report to DPS administration? | | |

|5. |Part of a report to fulfill a legislative mandate? | | |

|6. |Part of a report to fulfill requirements of a grant? | | |

|7. |Part of a quality assurance or program evaluation report? | | |

|8. |Part of a case study (publication of clinical scenario that has already occurred)? | | |

|9. |Other? Explain: | | |

C. Please briefly describe the data and methods you will use for these activities and answer the questions that follow.

I. Data:

II. Answer the following questions:

| |Note: to check a box, right click on the box then select properties; select checked under default value. |Yes |No |

|1. |Will you obtain data from a living individual about that individual? | | |

|2. |Will you obtain data via direct interaction with an individual? | | |

|3. |Will you collect information that is not available on the DPS Offender Search website? | | |

|4. |Do you need individual identifiers (e.g., Names, DPS numbers)? | | |

|5. |Do you need to enter a DPS facility to collect data? | | |

|6. |Do you need information about an individual who is involuntarily detained (e.g., prison, detention)? | | |

|7. |Do you need information about or plan to interact with individuals under 18 years old? | | |

|8. |Other? Explain: | | |

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