RESEARCH STUDY REQUEST FORM

Licensing PEDS Tools^® for Initiatives, Studies and Translations

Fields marked with an * are required

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YOUR CONTACT INFORMATION

YOUR CONTACT INFORMATION

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Name: *

Email *

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PLEASE DESCRIBE YOUR STUDY INITIATIVE:

PLEASE DESCRIBE YOUR STUDY INITIATIVE:

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Background *

Goals: *

Hypothesis and Expected Findings: *

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HOW DO YOU PLAN TO USE PEDS TOOLS^®?

HOW DO YOU PLAN TO USE PEDS TOOLS^®?

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How will you access our tools?

Which measures do you plan to use? *

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SETTING:

SETTING:

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Setting

How many sites:

How many professionals will administer the measure:

Other Setting

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FUNDING

FUNDING

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Is Your Project Funded?

Funding Details (if applicable)

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SUBJECTS

SUBJECTS

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How many children? *

Child's age range: *

Will you be testing the same children over time?

Will you be testing a 'special needs' population

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REFERENCES AND CONTACTS:

REFERENCES AND CONTACTS:

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What do you already know about this language in your country or internationally? How did you hear about us? *

In what country/countries will the study take place? *

What languages will be used? *

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START AND END DATES:

START AND END DATES:

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Start Date: *

End Date: *

How will you train others involved in your project on how to use PEDS Tools^®? *

Please provide names, titles/roles and email addresses for key professionals and administrators of your project *

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Note:

If received after business hours, on a holiday or weekend, we will begin processing your request on the next business day. Please allow up to ten business days. If you have any questions, please contact info@pedstest.com or call (877) 296-9972.

RESEARCH STUDY REQUEST FORM

Licensing PEDS Tools® for Initiatives, Studies and Translations

Licensing PEDS Tools^® for Initiatives, Studies and Translations