Note: This data request form has been adapted from Data Request Form used by the National Institute of Diabetes and Digestive and Kidney Diseases within the National Institutes…
Note: This data request form has been adapted from Data Request Form used by the National Institute of Diabetes and Digestive and Kidney Diseases within the National Institutes of Health. CERC-SON-UVI DATA USE REQUEST FORM CARIBBEAN EXPLORATORY RESEARCH CENTER SCHOOL OF NURSING UNIVERSITY OF THE VIRGIN ISLANDS Please complete this form to request the use of one or more datasets from the UVI-SON-CERC data repository. Requests should be sent via email to the Interim CERC Director, at nmichae@uvi.edu. * = Required Field Data Request Request Name* (ex: Research Project on CERC Data) Create a nickname for your reference. Requestor Information Full Name* Physical and/or Mailing Address* Email* Title (ex: Undergraduate Student) Name of Institution Phone (ex: 123-456-7890) For students(graduate/undergraduate): Advisor’s Full Name* Advisor’s Email Address* Note: This data request form has been adapted from Data Request Form used by the National Institute of Diabetes and Digestive and Kidney Diseases within the National Institutes of Health. …
Download the original document · Plain text (TXT) · Browse the archive · How this archive works
Original source: https://web.archive.org/web/20210509093317id_/https://cerc.uvi.edu/files/documents/CERC-SON-UVI%20Data%20Use%20Request%20Form%20Fillable.pdf
SHA-256 f626a7e1778672066777e584cba9c90b541fa766080a779fee05cc06a4f64bfa
Re-using this document
Our description, tagging, arrangement, extracted text and machine transcripts are released under CC0 1.0. We assert nothing about the document itself.
Archive identifier LF-f626a7e17786
Document text
Note: This data request form has been adapted from Data Request Form used by the National Institute of Diabetes and Digestive and Kidney Diseases within the National Institutes of Health. CERC-SON-UVI DATA USE REQUEST FORM CARIBBEAN EXPLORATORY RESEARCH CENTER SCHOOL OF NURSING UNIVERSITY OF THE VIRGIN ISLANDS Please complete this form to request the use of one or more datasets from the UVI-SON-CERC data repository. Requests should be sent via email to the Interim CERC Director, at nmichae@uvi.edu. * = Required Field Data Request Request Name* (ex: Research Project on CERC Data) Create a nickname for your reference. Requestor Information Full Name* Physical and/or Mailing Address* Email* Title (ex: Undergraduate Student) Name of Institution Phone (ex: 123-456-7890) For students(graduate/undergraduate): Advisor’s Full Name* Advisor’s Email Address* Note: This data request form has been adapted from Data Request Form used by the National Institute of Diabetes and Digestive and Kidney Diseases within the National Institutes of Health. CERC-SON-UVI Support Information Support Type (ex: Funding Award, MOA, MOU) Other Grant/PAR Number Request Details Study* Describe CERC study data being requested (IPV, YRBS, HSRP-VI, etc) Information Security: Please check the information security practices to be used. Institute supported, controlled access server. Institute supported, password protected, desktop computer. Encrypted, password protected laptop computer. Encrypted portable media (encrypted external hard drive, encrypted thumb drive) Unencrypted portable media backup (CD, DVD, thumb drive) stored in locked file cabinet. Study data must be maintained in a secure and controlled environment. Note: This data request form has been adapted from Data Request Form used by the National Institute of Diabetes and Digestive and Kidney Diseases within the National Institutes of Health. CERC-SON-UVI Comments Discuss how data security will be ensured (protocols installed on computer/s to be used) to meet HIPAA data security. Also indicate who else will have access to the data that is being requested for use. Agreement Form Title of Research Plan* Other Users* Provide names and institutional affiliation and role in proposed research study. Requested Materials*(Name of Data Set) Note: This data request form has been adapted from Data Request Form used by the National Institute of Diabetes and Digestive and Kidney Diseases within the National Institutes of Health. CERC-SON-UVI Description of Research Describe research to be conducted and key variables from dataset that will be used to support proposed research. Research Objectives and Design* Describe research design, research questions and/or research objectives as well as hypotheses to be tested, if any. Analysis Plan* Describe data analysis to be completed to answer research questions and/or test hypotheses. Note: This data request form has been adapted from Data Request Form used by the National Institute of Diabetes and Digestive and Kidney Diseases within the National Institutes of Health. CERC-SON-UVI Public Use Statement* This statement may be used by UVI-SON-CERC to describe how CERC data sets are used by various researchers. Please include a one-two (1-2) paragraph statement which may be made publicly available. Include information about the intended audience for the research results and the benefits to the participants and/or community or to the advancement of science.