AMIkids Data Request and Study Proposal Application

Please complete this application if you are interested in requesting data or proposing a study of AMIkids. Applications will be reviewed within 10 business days of receipt. If you have any questions, please email DataandResearch@amikids.onmicrosoft.com.

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* 1. Principal Investigator (PI):

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* 2. PI Job Title:

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* 3. Application Contact Information:

Name (if different from PI)

Company or Organization

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 4. Additional Contact Information:

Name

Title

Email Address

Phone Number

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* 5. Title of project or study:

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* 6. Goal of the study:

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* 7. Study time period:

Anticipated start date:

Date

Anticipated end date:

Date

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* 8. Funder(s), if any:

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* 9. Funding available for AMIkids, Inc. (Home Office)?

Yes

If yes, please indicate the amount:

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* 10. Funding available for AMIkids programs?

Yes

If yes, please indicate the amount:

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* 11. Intended product(s) (e.g., white paper, published report/article/book, peer-reviewed publication, dissertation/thesis) and audience(s):

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* 12. Project or Study Abstract:

Please include: 1) A description of the study goals, objectives, and hypotheses to be tested; 2) A summary of the project’s methodology; 3) A summary of the project’s analysis procedures, indicating how the data will be used; 4) A description of any data files that will be linked with the data provided by AMIkids, specifying the source of these data files; and 5) A description of how the results of the project or study will be disseminated.

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* 13. Has this research project or study been reviewed and approved by an Institutional Review Board for Protection of Human Subjects (or equivalently, reviewed and determined to not represent human subjects research)?

Yes (upload a copy of the approval letter, IRB application, and any other materials submitted with the application in the next section)

No or Pending (note that approval or documentation of exemption will be required prior to any sharing of AMIkids data)

Comments:

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* 14. If available, please upload a copy of an approval letter from your governing Institutional Review Board for this project.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 15. Data Requested:

Describe the type of data/specific variables requested (specify date range if applicable, ages, youth characteristics, geographic locations, etc. as relevant).

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* 16. How will you maintain confidentiality, access to, and security of identifiable data or other confidential materials obtained from AMIkids? Include an explanation of how copies of data extracted from them will be stored. Explain how and when you plan to destroy or return copies of data files after your project is completed.

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* 17. If you plan to share data with others, specify how they will be shared and whether the data will be anonymous.

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* 18. How will the proposed research benefit (a) AMIkids and/or the specific partnering agencies and (b) the field of youth development or juvenile justice more generally? What new knowledge will be gained and what potential difference could it make?

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* 19. How will the study findings will be shared with AMIkids and any partnering agencies?

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* 20. Please upload a completed and signed AMIkids Confidentiality Agreement:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Assurances

The undersigned hereby agrees to the following terms and conditions related to this application and the use of the information obtained from AMIkids.

A. The identifiable data obtained from AMIkids will be used only for the project proposed and the purposes described in this application. Use of the information for purposes other than those described will not be undertaken until a separate application form for the project has been submitted to, and approved by AMIkids.

B. Confidentiality and handling of the information obtained will be maintained as described in this application and pursuant to the terms of a separate Confidentiality Agreement, a sample of which is attached, that applicant must enter into with AMIkids.

C. Copies of records, computer listings or electronic files abstracted from records obtained through this application will be returned to AMIkids or destroyed following their described use as detailed in the application section on use of data and in compliance with terms of Data and Evaluation Tool Confidentiality Agreement.

D. No information will be released to or used by any organization/agency other than the undersigned, except as shown in this application and approved thereafter.

E. AMIkids reserves the right to remain anonymous in the research. Whether and how AMIkids will be credited is to be determined upon completion of any final products but before dissemination or publication of them in accordance with terms of Data and Evaluation Tool Confidentiality Agreement.

F. AMIkids will be provided a copy of any research papers or reports a minimum of 3 weeks before they are submitted for publication, presentation, or other dissemination to review and to raise reasonable questions or concerns regarding the use of data provided by AMIkids in such products. Researcher will address such concerns regarding data use to the reasonable satisfaction of AMIkids. One satisfactory mechanism for which will be to include a separate commentary from AMIkids as part of the product or to alert users/readers to the existence of this commentary and how to access it. As relevant, the review process will be repeated for all final presentations or publications that have been reviewed only in proposal or draft form, but with a minimum of only one week lead time required for this type of review.

G. All the statements made in this application are true, complete and correct to the best of my knowledge and belief.

H. I am an authorized signee at my organization to enter into this agreement.

I. I understand that at no time will anyone other than an officer of the Corporation of AMIkids or their AMIkids Team Member designee have the ability to bind AMIkids to any relationship or agreement.

J. I understand that failure to comply with the above terms and conditions will result in the following:
1. The immediate termination of access to protected AMIkids data for this project and all other previously approved projects conducted by me or my organization.
2. Potential prohibition from access to protected AMIkids data for all future projects conducted by me or my organization.

AMIkids Data Request and Study Proposal Application

Question Title

* 1. Principal Investigator (PI):

Question Title

* 2. PI Job Title:

Question Title

* 3. Application Contact Information:

Question Title

* 4. Additional Contact Information:

Question Title

* 5. Title of project or study:

Question Title

* 6. Goal of the study:

Question Title

* 7. Study time period:

Question Title

* 8. Funder(s), if any:

Question Title

* 9. Funding available for AMIkids, Inc. (Home Office)?

Question Title

* 10. Funding available for AMIkids programs?

Question Title

* 11. Intended product(s) (e.g., white paper, published report/article/book, peer-reviewed publication, dissertation/thesis) and audience(s):

Question Title

Question Title

* 13. Has this research project or study been reviewed and approved by an Institutional Review Board for Protection of Human Subjects (or equivalently, reviewed and determined to not represent human subjects research)?

Question Title

* 14. If available, please upload a copy of an approval letter from your governing Institutional Review Board for this project.

Question Title

* 15. Data Requested:Describe the type of data/specific variables requested (specify date range if applicable, ages, youth characteristics, geographic locations, etc. as relevant).

Question Title

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* 17. If you plan to share data with others, specify how they will be shared and whether the data will be anonymous.

Question Title

* 18. How will the proposed research benefit (a) AMIkids and/or the specific partnering agencies and (b) the field of youth development or juvenile justice more generally? What new knowledge will be gained and what potential difference could it make?

Question Title

* 19. How will the study findings will be shared with AMIkids and any partnering agencies?

Question Title

* 20. Please upload a completed and signed AMIkids Confidentiality Agreement:

Question Title

* 21. Application Signature (please type your full name to agree to the assurances listed above):

* 15. Data Requested:

Describe the type of data/specific variables requested (specify date range if applicable, ages, youth characteristics, geographic locations, etc. as relevant).