Request to Obtain Membership Information for Research Assessment Purposes Form

All researchers must be ACPA members.

Contact Information

REQUIRED

First Name*

REQUIRED

Last Name*

REQUIRED

Title*

REQUIRED

Institution*

REQUIRED

Phone*

REQUIRED

Department

REQUIRED

ACPA Membership Number

REQUIRED

Mailing Address

REQUIRED

City, State, Zip/Postal Code, Country

REQUIRED

Email Address*


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Personal Information

REQUIRED

Level*





Letter from Faculty Advisor (If Applicable):

Please upload a letter from your faculty advisor which includes their name, title, department institution, email, phone number, and signature below the following statement:

"I agree to supervise this student’s research or assessment project and I will assist this student in maintaining appropriate research ethics. I also understand the application review process may take 3-4 weeks to complete"

REQUIRED

Faculty Letter*
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Survey Requests

ACPA does not allow surveys to be sent to all members. Researchers are asked to focus their studies on a specific position level (entry, mid or senior) or primary job function (see ACPA membership form for a complete list).

Study Information

Please briefly describe the purpose of your study, including:

REQUIRED

1) the connection of your study to ACPA’s organizational mission*

REQUIRED

2) the timeline for mailing and anticipated duration of your project; and*

REQUIRED

3) the expected outcome of your study (e.g., dissertation or thesis, publication, conference presentation).*

REQUIRED

Please submit a copy of your survey questions.*
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Human Subjects Information

REQUIRED

Please attach a copy of your institution’s Human Subjects or Institutional Review Board (IRB) approval for this study.*
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REQUIRED

If there are any risks associated with this study, please detail them in the space below.*

REQUIRED

Verification of Information*

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