Student Request Form Research/Purchase Request Form Student request form for research projects and purchases. Name* First Last Today's date* MM slash DD slash YYYY Email* Phone*Team name* Lab instructor*EislebenEnloeFlinkFuenfhausenFrisbyFullerHeathHigginbothamLorenzParnellClient*Boone County Health Dept. - Postpartum DepressionBoone County Health Dept. - Fit-Tastic!Boone Hospital CenterCancer Research CenterCustom Complete AutomotiveFOX SportsGlobal JournalistMissouri Dept. of Health and Senior ServicesMizzou OnlineMU School of Journalism - RecruitmentMU School of LawMU SustainabilityNews SharingNSAC - WeinerschnitzelPedNet Vision ZeroSilver Fox BoxSoutheastern MissourianRJIWhat's this about?* Research-related purchase Non-research-related purchase This form should be filled out and submitted ONE WEEK before you need to make the purchase. Please allow two business days for this form to be processed. Approval must be obtained prior to any purchase or expediture. Amount requested*Item(s)/service(s) to be purchased:*As best you can, please list general line items with costs for each purchase.What will this purchase be used for?*(ex. final presentation, prop, giveaway, swag, etc.)Where will this purchase be made?*(ex. Kinko’s, online, Fast Yeti, etc.) When will this purchase be made?* MM slash DD slash YYYY NOTE: Please submit only one form for each study. Methodology* Survey Focus Group Interview Estimated start date for research* MM slash DD slash YYYY Estimated end date for research* MM slash DD slash YYYY Estimated start date for compensation of research participants*This is important for departmental bookkeeping. (i.e. When do you plan to begin compensation?) MM slash DD slash YYYY BudgetEstimated Budget*This includes anticipated costs for subject recruitment and subject payment, as well as additional purchases such as specific support materials and equipment (if your study requires them). Document everything you plan on purchasing as line items. For example: "Subject payment: $100" You'll be asked to provide more information on each of these line items later in the form.Item or purposeCost Will you offer ALL of your subjects payments?*Please read this question carefully. Yes (all of my subjects will receive payments) No (payments will be randomized) Number of subjects*Number of subjects to receive payments*Amount of each subject payment*Amount subjects will receive in total*Method of payment*NOTE: Amazon gift cards are only offered in the following increments: $5, $10, $15, $25, $50, and $100. University check Amazon gift card Will your study require additional purchases?*This includes anything outside of subject payments. (e.g. snacks, costumes, interactive elements, etc.) You should have already answered this in the "Estimated Budget" section, but we need more information for MU accounting purposes. Yes No How many additional purchases does your study require?*123Additional Purchase 1HiddenAmount requested*Estimated cost of purchase:*Item(s)/service(s) to be purchased:*What will this purchase be used for?*Place where item(s) will be purchased:*When will this purchase be made?* MM slash DD slash YYYY Additional Purchase 2HiddenAmount requested*Estimated cost of purchase:*Item(s)/service(s) to be purchased:*What will this purchase be used for?*Place where item(s) will be purchased:*When will this purchase be made?* MM slash DD slash YYYY Additional Purchase 3HiddenAmount requested*Estimated cost of purchase:*Item(s)/service(s) to be purchased:*What will this purchase be used for?*Place where item(s) will be purchased:*When will this purchase be made?* MM slash DD slash YYYY Date MM slash DD slash YYYY Δ