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Please complete the following research application. Provide all information requested as part of this
application. Do not simply refer to other documents or grant applications. Once completed, send this form,
with the attached Research description, and all supporting documents (email preferred) to the Institutional
Review Board chair: Dr. Kristen Thompson, (7122); irb@loras.edu
Ethics Certification: In submitting this review request, you agree to conduct this research as described in the
attached documents. You agree to request and wait to receive approval from the IRB for any changes to the research
proposal. You will comply with the policies for conducting ethical research as outlined in the Belmont Report (at
http://www.hhs.gov/ohrp/policy/belmont.html .) and other applicable professional ethical standards.
Please watch the video The Belmont Report: Basic Ethical Principles and Their
Application from the Office for Human Research Protections of the U.S.
Department of Health & Human Services, from the beginning of the program to
minute 13, available at www.youtube.com/watch?v=Up09dioFdEU . Your
electronic signature in the space below affirms that you have watched the video
and understand the ethical principles presented:
Kayla Kinney
Kayla Tilkes
Gabrielle Cullen
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2. Participants
Recruitment:
An email will be sent to adults who have children between the ages of 0 and 4. Those who are
interested will reply to the email and one of the researchers Kayla, Kayla, or Gabrielle will send the
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individuals links to the online questionnaire and articles. The links will be assigned to the individuals
randomly.
Consent:
A consent form will be sent along with the initial email about the study. Participants who want to be
a part of the study will electronically sign the consent form and email it back to the researchers.
Collaboration: N/A
5. Data Handling
Data will be kept confidential and only the researchers, Gabrielle and both Kayla’s will be able to see
the data, as well as Professor Grinde. The data will be stored in a single folder from March 2019 to May
2019. No audio or video tapes will be used. We plan on sharing the results of this research in our Research
Methods and Statistics II class. The data will be presented in person and on a poster.
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INFORMED CONSENT
You are being asked to participate in a study conducted by Loras College Psychology
students in a Research Methods & Statistics class. The principal researchers that are conducting this
study include Gabrielle Cullen, Kayla Kinney and Kayla Tilkes. This research is monitored and
supervised by our faculty sponsor, Lisa Grinde.
The purpose of this research is to investigate how parents of young children perceive the
benefits and risks of sport participation. We are asking that 36 participants participate in this study.
Each participant will be able to complete this research study in the comfort of their home on their
personal computer, laptop, or phone. You will receive an article to read and then will fill out an
online questionnaire. This procedure will take about 15-25 minutes.
Participation in this research project carries a small risk which might be that you could be
more hesitant in letting your child participate in sports after reading the article or you may
experience discomfort with the information presented; however, this risk factor is minimized by the
fact that all observations will be recorded anonymously to ensure the participant’s privacy. All data
will be kept confidential and only between the researchers. Through participation in this research
project you may benefit personally by learning more about sports. Furthermore, no compensation
will be given for participating in this research.
Participating in this research project is voluntary, and you may withdraw from it at any time
without penalty– even after you have started it. Questions may be skipped if you feel uncomfortable
answering. If you have any questions regarding the study, please contact any of the principle
researcher: Gabrielle Cullen (gabrielle.cullen@loras.edu), Kayla Kinney (kayla.kinney@loras.edu)
and Kayla Tilkes (kayla.tilkes@loras.edu). If you have any questions or concerns about your rights
as a research subject, please feel free to contact the Institutional Review Board Chair at Loras
College, Kristen Thompson (kristen.thompson@loras.edu).
X_____________________________________
Signature
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X_____________________________________ Date________________
Your signature indicates that this research study has been explained to you, that your questions have
been answered, and that you agree to take part in this study. You may request a copy of this form.
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How aware are you about the effects of concussion? (not aware) 1 2 3 4 5 (very aware)
How worried are you about your child’s risk for concussion?
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Please list any sport(s) you would not want your child to participate in and briefly explain why.