ࡱ> UXT Cbjbjv)v) nJCAgCAgB$BBBBl4B#t\>>> $3 # # # # # # #$R%(`/#i |  /#>#i"i"i" > #i" #i"i"i"> i""#0#i"h( h(i"h(i" i" /#/#! # h( X : Capstone Project Proposal A. Contact Information Student Name:  FORMTEXT       Phone:  FORMTEXT       MCW Email:  FORMTEXT       Alternate Email:  FORMTEXT       Faculty Advisor:  FORMTEXT       Phone:  FORMTEXT       Email:  FORMTEXT       Second Reader:  FORMTEXT       Phone:  FORMTEXT       Email:  FORMTEXT       B. Information Needed if Coordinating with a Site Site Name:  FORMTEXT       Website:  FORMTEXT       Address:  FORMTEXT       Contact Person:  FORMTEXT        FORMTEXT       Email:  FORMTEXT        FORMTEXT       Phone:  FORMTEXT       Does this site have its own IRB?  FORMCHECKBOX  No  FORMCHECKBOX  Yes, please identify:  FORMTEXT       Will the site require an IRB to review this project prior to initiation of any activities?  FORMCHECKBOX  No  FORMCHECKBOX  Yes C. Project Description and Logistics Date CITI training completed:  FORMTEXT       Will you receive any funding via a research grant to complete this project?  FORMCHECKBOX  No  FORMCHECKBOX  Yes Will you be working directly with any identifiable private health information?  FORMCHECKBOX  No  FORMCHECKBOX  Yes Will you be interacting with possible participants (i.e. administering surveys or  FORMCHECKBOX  No  FORMCHECKBOX  Yes questionnaires, conducting focus groups)? Are you planning on publishing or submitting this project as a poster abstract or journal article?  FORMCHECKBOX  No  FORMCHECKBOX  Yes Project Dates:  FORMTEXT       Project Title:  FORMTEXT       D. Narrative description of your Capstone Project should include: 1. Rationale Concise statement of the purpose and question(s) you are trying to address. 2. Project Design a. Narrative of the project procedure in the sequence in which the project segments will be performed. b. Description of data/information that will be gathered. Indicate if you will be working with private health information and/or interacting with possible participants. c. Explanation of each method or approach to be utilized. 3. Materials Explanation of any instruments or materials you intend to utilize. Provide sample questions if using surveys or questionnaires. 4. Data Analysis or Evaluation a. Intended analytic technique, or b. Evaluation plan. 5. Anticipated Outcomes a. Knowledge or product that can be expected as a result of your project. b. Potential significance of the results, including public health relevance. c. Dissemination plan. 6. References Include any references utilized in developing the proposal. 7. Course Requirements a. Timeline, including identification of when deliverables will be submitted. b. Competencies (at least 5 foundational and 1 concentration-specific) that will be enhanced during the Capstone Project. E. Responsibilities Student responsibilities in carrying out the project: 1. Develop and submit a proposal for the Capstone Project to the faculty advisor and program coordinator for review and approval. 2. Maintain CITI (Collaborative Institutional Training Initiative) certification throughout enrollment in the Capstone Project course. 3. Obtain 91ɫƵ IRB approval if deemed appropriate by the MPH Program. 4. Submit drafts of the Masters Paper to the faculty advisor and a secondary reader for review and comment. 5. Submit a final draft of the Masters Paper to the faculty advisor within the course guidelines and timeframes. 6. Develop and deliver a PowerPoint presentation on the purpose, methods, results, discussion, and conclusions of the Masters Paper. Faculty advisor responsibilities in guiding the student: 1. Provide guidance to the student, as needed, in the development of the Capstone Project. 2. Review and approve the Capstone Project proposal. 3. Act as the Principal Investigator for the students application to the 91ɫƵ IRB if deemed appropriate by the MPH Program. 4. Review drafts of the Masters Paper and provide guidance, resources, and constructive feedback. 5. Evaluate the Masters Paper and submitted presentation, and assign the final grade for the Capstone Project course. F. Agreement & Approval The persons whose names are listed below have participated in the development of this Capstone Project2468fh  tl\ttjthIbh[J5UhIbh[J5jhIbh[J5UhS+jhIbh[J5QJU^JmHnHujh[Jh[J5Uh[Jh[J5jh[Jh[J5Uh[J h8hShMhSCJaJhMhS5 hS5 h0hShS5CJaJh8hS5CJaJ#468fhp r ( * D F  Phx^hgd[J Px`gd[J Pxgd[J Pxgd[Jxgd[JgdS$a$gdS      " $ & D H J ^ ` b d f h j l n p r  ɦjDh[Jh[J5Ujh[Jh[J5Uh0hSCJaJj\h[Jh[J5Uh[Jh[J5hSh[J#jh[Jh[J5UmHnHujh[Jh[J5Ujh[Jh[J5U4      " $ & ( * D H J ^ ` b d f h j l n p z ~ Ĺĵڵĵĵjh[Jh[J5Ujh[Jh[J5Uj,h[Jh[J5Uh[Jh0hSCJaJhS#jh[Jh[J5UmHnHujh[Jh[J5Ujh[Jh[J5Uh[Jh[J53 < D F X \ ^ r t v x z | ~    0 ʺҨʘҨ}Ҩjvh[Jh[J5Uh*-hSCJaJjh[Jh[J5U#jh[Jh[J5UmHnHujh[Jh[J5Uh[Jh[J5jh[Jh[J5Uh[JhShMhSCJaJhMhS5 hS51 B   JLQv R t"%gdF} t"%xgdF} t"%xgdF}xgd[J hx^hgd[J VPhx^hgd[J Phx^hgd[J0 2 4 6 8 : < > @ B D F Z \ ^ ` b d f h j l v z | jh[Jh[J5UjNh[Jh[J5Ujh[Jh[J5Ujbh[Jh[J5Uh[Jh[J5h[JhS#jh[Jh[J5UmHnHujh[Jh[J5Ujh[Jh[J5U2   F H d f h r t ұҟݛq#j h*-hw!CJUaJj" h[Jh[J5Uh[Jh[J5h[J#jh*-hSCJUaJ#j:h*-hw!CJUaJjh*-hSCJUaJh*-hSCJaJhS#jh[Jh[J5UmHnHujh[Jh[J5U)JL$%345ƻڷuqqbWEb#j hTchF}CJUaJhTchF}CJaJjhTchF}CJUaJhF}hhSCJaJ#jh[Jh[J5UmHnHuj h[Jh[J5Uh[Jh[J5jh[Jh[J5Uh[JhMhSCJaJhMhS5 hS5 hGhShSjh*-hSCJUaJ#j h*-hSCJUaJ5:;IJKLPQ ./0156DEFGuvo#j hTchF}CJUaJ#jD hTchF}CJUaJ#j hTchF}CJUaJ#jX hTchF}CJUaJ#j hTchF}CJUaJ h2hF}#jl hTchF}CJUaJhTchF}CJaJjhTchF}CJUaJhF}+  &*,@BDFHJLNPRlpr~nidi\h4+hS5 hq5 hS5jh[Jh[J5Uh0hSCJaJ#jh[Jh[J5UmHnHujh[Jh[J5Uh[Jh[J5jh[Jh[J5Uh[JhS hF}hShF}#j0hTchF}CJUaJhTchF}CJaJjhTchF}CJUaJ$ :b FS)A9 8^8`gd5f hh^hgdS 8^8`gdSh^hgdS 8^8`gdS ^`gdSgd=/5 :lb FS)AOP79P./ehmnq #hQ hM^hS hy~hSh5-hS5 hS5h>zhNThat h5fh5fh5fhSN9P./en R^8 d^gdS L^`LgdS L^`LgdSgdS$a$gdSgd=/5 8^8`gdS hh^hgdS"RU]^a789:;GRSTX^@L@M@V@W@AAA1A;AAABEBFBOBPBiBzB{BBBBBBBBBB¾¾¾¾¾¾µ jh?hj9UmHnHu h?hj9Uhj9 h'"hj9h'"hj95h?hj95 hj95hM^hS6h5f hM^hS hy~hShQhS>89:STAAEBFBiBBBBBWC $h^ha$gdj9 $  a$gdj9$ # p@ P $a$gdj9$ T!a$gdj9$ T!a$gdj9gdj9$a$gdj9 $@&a$gdj9$a$gdS Proposal. They have agreed to the responsibilities listed under their roles in Part E of this document, and they indicated their approval of this proposal. The student indicated his/her approval and agreement by submitting his/her proposal. The Faculty Advisor provided his/her approval and agreement through an email to the Program Coordinator. If any changes need to be made to this document, each individual has agreed to make those changes known to all other persons whose names appear below. (This section to be completed by the Program Coordinator and IRB Consultant.) 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