Funding Source Request

							                           School of Nursing Research Support Services
                                                                 FEE-FOR-SERVICE REQUEST
                                                  FORM



                    School of Nursing Faculty -- Fee-For-Service Rate: $60/hr

                  Non-School of Nursing Faculty – Fee-For-Service Rate: $70/hr

   Please note requests need to be approved by the Assistant Dean (Research), School of
                                         Nursing



                               SON Research Office Use Only
Primary Contact Name:
Project ID:
Date of Consultation:


Department or Agency Contact Information

Dept or Agency Name:                      Telephone:
Contact Name:                             E-Mail:
Address:                                  Fax:



If you are a McMaster Faculty Member, please indicate your currents status:

   Full-Time           Part-Time               Clinical     Other:




Project Details
 Study title:



Please provide a brief description of study:




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                                            School of Nursing Research Support Services
Assistance Required (check all that apply)

Study Coordination

We provide coordination support that may include any of the tasks in the sections below and
additional responsibilities as negotiated. Support is a maximum of .5 FTE on one project.

Are you wanting study coordination?

  Yes, I am interested in study coordination for my project: Please check any tasks in the following
sections.

   No, I only want assistance with specific tasks: Please check tasks you require in sections below.

Start-up Activities

Please indicate required areas of assistance:
  Prepare ethics review board application
  Create information letters or consent forms
  Develop promotional materials
  Train project-specific research staff
  Other (please specify):


Data Collection

Please indicate where the data collection will occur:
  McMaster central campus
  Hospital site (please specify):
  Community location (please specify):
  Other (please specify):

Please indicate mode of data collection:
  Mailed questionnaires
  On-line survey
  Telephone survey
  Focus group interviews
  Face-to-face interviews
  Telephone interviews
  Other (please specify):

Please indicate duration of data collection period:
Start Date:
End Date:




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                                            School of Nursing Research Support Services
Data Management and Output

   Create on-line survey
   Establish SPSS/Excel database
   Enter data in SPSS/Excel
   Perform basic data analysis with SPSS/Excel
   Create SPSS/Excel tables and figures
   Analyze qualitative data
   Generate reports and summaries


Dissemination Activities

   Conduct search to update literature
   Assist with preparation of research reports*
   Assist with manuscript writing*
   Prepare posters or presentations
   Other knowledge transfer activities (please specify):
* Note: Authorship to be negotiated where applicable




Please list any additional information or tasks




Last updated November 2012                                                     3|Page