Request for Permission to Conduct Research at the RVTTI 1. Name of Principal Investigator:______________________________________________ 2. Institutional Affiliation: ____________________________________________________ 3. Degree/Diploma Sought (if applicable)________________________________________ 4. Mailing /Email Address:____________________________________________________ 5. Phone:__________________________________________________________________ 6. Category of Research: Indicate the type and form of research to be conducted (e.g., interviews, survey)________________________________________________________ ________________________________________________________________________ 7. Research Subjects: Indicate from whom data will be collected (e.g., lecturers, students, nonteaching staff, documents) _______________________________________________________________________ 8. Has your research proposal been approved by your university's unit responsible for ensuring compliance with regulations governing research involving human subjects? _____ Yes ____ No (attach a copy of the approval to this form). 9. State the title of research/project: 10. Purpose (briefly identify the purpose[s] of your study): ___________________________ ________________________________________________________________________ 11. Why is it important or necessary to conduct your research at RVTTI? ________________________________________________________________________ ________________________________________________________________________ 12. What are the timelines for administering your research? __________________________ 13. When and where do you anticipate reporting the results of your research? ________________________________________________________________________ CONDITIONS FOR MAINTAINING ETHICS AND SHARING PROJECT RESULTS I agree to maintain the anonymity of individual students, staff members and RVTTI in any report(s) and in any publication(s), e.g., journal article(s), book(s), etc., which incorporate any information derived from the research conducted within RVTTI. I agree that if information about subjects is disclosed, including personal characteristics and confidential data concerning RVTTI during research, I ensure that they will not be at risk for damage to their financial standing, employability, or reputation I agree that this study does not involve deception (i.e., withholding from or giving false or misleading information to subjects/institution) I agree that the procedures do not cause any degree of discomfort, harassment, invasion of privacy, risk of physical injury, threaten the dignity or otherwise potentially harm subjects/institute. I agree to provide the Office of Research and Development with the research results, complete documentation and information on the location of the complete research and, in the future, subsequent publications. Signature of the Researcher ……………………………… Date …………………….. Instructions: Attach a copy of cover letter, the research instruments, consent form, debriefing statement (if research involves deception) and NACOSTI approval to this form. Send all materials to: Research and Development Coordinator RVTTI, P O BOX 244-30100, ELDORET Or email to: [email protected] & [email protected]
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