Application to Post a Request for Research Participants to the APAHC Listserv

Name

First Name

Last Name

Attestation

I acknowledge that the study has received IRB approval or is exempt from IRB approval.

IRB Number:

Approving Institution:

Title of study:

Brief description of the study

Requirements of participation (e.g., complete one survey, complete multiple surveys)

Inclusion/exclusion criteria

A statement specifying how privacy and confidentiality of individuals’ responses

A statement specifying whether or not there are any incentives for participation

The mission of APAHC is to strengthen the role of psychology and behavioral science in health care research, clinical care, and the education of medical students, graduate students, pre- and post-doctoral psychology fellows, intern and resident physicians, and other health professionals. Please describe the reason[s] that you are interested in surveying psychologists in medical settings. How is this survey consistent with the mission of APAHC and the interests of its membership?

At least one member of the research team must be a member of APAHC. Please list the members of the research team who are members of APAHC:

All requests will be evaluated by a committee comprised of a subset of members of the APAHC Research Committee. Unapproved posts are not permitted. To balance the goals of researchers with the purpose and goals of the APAHC listserv, only a limited number of requests are approved each month. Approved applications will consist of research that is consistent with the mission of APAHC and/or will be research in which the members of APAHC are the primary recruitment pool.

The role of APAHC in approving a request to post to its listserv is to provide access to psychologists in academic health centers. Approval to post on the listserv is not an endorsement of the quality or soundness of the research design or methodology, nor its subject matter. If your request is approved, the initial post to the listserv and one follow-up post will be sent by APAHC in digest form once a month with other approved requests. APAHC reserves the right to remove from the listserv any posting that violates the rules or is problematic for any reason

Application to Post a Request for Research Participants to the APAHC Listserv

Association of Psychologists in Academic Health Centers