Research Request Form

MSHA Supports Research

To request the use of the MSHA listserv for research, please complete the following form.

If MSHA approves your request, your survey will be disseminated to the MSHA membership.

Every effort will be made to send your survey out in a timely fashion. Please keep in mind that all MSHA membership correspondence takes precedence when sending out listserv messages.

Precedence will also be given to those requesting surveys that are current MSHA members.

Once you request is approved, you will be asked to develop a message that will go to the membership to announce your research survey. Your message must contain your contact information (phone number and e-mail address) and the survey link. The MSHA listserv does not support graphics or attachments. Messages that do not conform do these requirements will not be sent to the membership.

Complete the following to request your research to be shared with MSHA members.

First Name *
Last Name *
Phone *
Email *
Are you a current MSHA member? *
YesNo
University and department overseeing the research *
Names of all persons involved and relationship to the project, including Faculty sponsor(s) *
Title of Research *
Provide a brief description of the research that includes the purpose, procedure, benefits of the study, risks if any and how findings will be used *
If your project is selected, provide a brief description (200 words max) that we can use in an email to our members. Be sure to include a link to your survey/project website. *
Start date for participants
End date for participants
Requirements for needed participants
Confidentiality Statement
Institutional Review Board (IRB) approval date

Verification

Please enter any two digits *Example: 12
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MSHA Supports Research

Complete the following to request your research to be shared with MSHA members.

Verification

Resources