Please email qld.award.office@qed.qld.gov.au to request any of the below resources: P3 Adventurous Journey medical consent form. Address Postcode. PARTICIPANT TRANSFER FORM. Introduce yourself and invite people to participate in your research. The Duke University Research Support Services Agreement (RSSA) should be utilized to procure outside services on sponsored codes (20x-28x, A03, and 30x-38x). Participant’s Duke Unique ID Number (if a Duke Employee): Participant’s Social Security Number: - - If you do not want to provide your social security number, write your initials here _____. Contact Us. I consent to transferring their Duke of Ed registration to New Award Leader. Duke Surgery provides a range of surgical services from routine surgery to the most complex procedures, including experimental and highly specialized treatments. It is a contract between Duke and the contractor. Fill out form on line and email to productrequest@duke.edu. Connect with us on Linkedin. The below forms are for Award Centres and adult volunteers. The Purchase Requisition template you download will have a space for a tracking number. Duke Health has implemented a compliance Within DUHS use of a short form consent document is largely limited to two situations: Participant Application Form under 18 (parental consent required) Participant Application Form over 18 (no parental consent required) Guidelines. You can download our Participant App to access the Online Record Book anytime, anywhere. An additional goal of this research is to collect more information on chemical applications in residential furniture over time and within different areas of the United States. EXCURSION INFORMATION AND CONSENT FORM . The Duke of Edinburgh’s International Award is a non-formal education and learning framework operating in more than 130 countries and territories around the world, through which young people’s achievements outside of academia are recognized and celebrated. This is a document internal to Duke University and should not be sent to an outside organization or vendor. Generally, a foreign vendor is subject to U.S. tax on its U.S. sourced income. I have been allowed to ask questions, and my questions have been answered to my satisfaction. For more information call 13 13 02. The Sole Source Justification/Price Quote Selection Form should be utilized when an explanation as to the unique nature of the purchase of a good or service from a vendor on sponsored funds is necessary. It is required by the federal government to ensure they are not funding duplicative equipment. Participant Application Forms. Please check the following guidance as to the level of communication required. The IRI you download will have a space for the number. We request that all group organisers contact us to keep us informed of their planned visit to the New Forest. If you filled in the registration form last year, most of the contact details should be filled out. Mobile phone Date. Completed form must be attached to an Accounts Payable Check Request when requesting payment for individual services, or it must be attached to a Purchase Requisition when you are requesting a Purchase Order. The number will be referenced in the description field. • I consent to (insert participant’s name) _____’s participation in the above Adventurous Journey (AJ), including travel. SUMMARY OF DETAILS First Name Last Name School Confirmation Number CONSENT - Please read carefully, initial the box and sign at the bottom to give your consent. These policies are based on the applicable regulatory requirements or current safety guidelines. The undersigned consents to any X-ray, examination, laboratory, procedures, anesthesia, minor surgical procedures or any medical services rendered under the general or specific instruction of the Duke City Primary Care physicians. An OSA must be completed when engaging individuals or companies to perform certain outside services. This form is used for non-resident alien payments of other than substantiated expenses. Duke Human Resources 705 Broad St. This form is used to determine if an individual performing services for the University qualifies (per the IRS) as an Independent Contractor or must be paid as a Duke employee. The Urban Odyssey is our gold level Duke of Ed version of our program. It is where Participants can set up activities, record their efforts, upload evidence and submit assessor reports. The undersigned consents to any X-ray, examination, laboratory, procedures, anesthesia, minor surgical procedures or any medical services rendered under the general or specific instruction of the Duke City Primary Care physicians. Participant’s Duke Unique ID Number (if a Duke Employee): Participant’s Social Security Number: - - If you do not want to provide your social security number, write your initials here _____. Once registered you can log in using the App. I understand that the outdoor nature of the AJ program will involve risks. I consent to the Award Centre and any other individuals, including Volunteers#, who are involved in or assist in organising The Duke of Ed, and hired transportation drivers, transporting the Participant for the purpose of participating in activities or functions related to The Duke of Ed, as required. A “statement of research” is a required component of informed consent. To be accompanied by Research Support Services Agreement (RSSA). We are asking you to complete your Authorization form now. Flinders Island District High School student first to receive Bronze Duke of Ed Award this century on the Island. All laboratory equipment must be free of hazardous materials (e.g. IRS Form W-9, Request For Taxpayer Identification and Certification is used by payers to properly report tax information from miscellaneous payments made to either, Duke University (for grants, contracts, interest, etc.) By continuing to use our website without changing the settings, you are agreeing to our use of cookies. – Blue expedition form – overseas. This is accomplished through the development and implementation of policies and procedures that are intended to provide guidance for worker safety when handling biological agents. The Duke of Edinburgh’s International Award is a non-formal education and learning framework operating in more than 130 countries and territories around the world, through which young people’s achievements outside of academia are recognised and celebrated. If you experience any technical problems with the Online Record Book, you can contact the National Award Operator: Online: Record book help Email: orb@dukeofed.com.au Phone: 1300 4 DUKES (1300 438 537) (select option 1) The screening form should be appear in the “Notes & Attachments” of the corresponding Buy@Duke cart. The paper Purchase Requisition should ONLY be used in rare occasions when an electronic requisitions are NOT appropriate (examples: leases, standing purchase orders for DUHS). Due to the wide variety of device configurations that access the LMS at Duke, it can be difficult to prevent all issues when launching e-learning courses and content from the LMS. This document MUST NOT be altered. Can eConsent be used on all projects? Signature Work phone. ). Use this for to order banking supplies (deposit tickets, bank bags, etc.). In such cases, the consent form may be placed under the “Media” tab in the electronic record. Click Here for examples of the concise summary that must appear at the top of the consent form. Suite 4, Level 3, 189 Kent Street, Sydney 2000, NSW; 1300 438 537; admin@dukeofed.com.au Package including Letter from Accounts Payable, Statement of Compliance, W-9, Vendor Information Form. III. Advanced Search. – Sample enrolment form for participants. Starting The Duke of Ed; Continuing to the next level; Cost; Starting The Duke of Ed Before you apply. Either use a separate consent form or ensure that the consent request is kept separate at the bottom of a form. Once we receive your registration form and payment, we will send you a Participant Record Book, Expedition Guide and helpful hints and tips on completing your Award! Leader Registration Form. This form should also be submitted when submitting items to surplus valued up to $20,000. (a.k.a. – eDofE data change request form. We have now separated the sample consent form into an Adult version and a Minor version. You will be notified by email with the necessary information. The use of this form is expected to be on an exception basis and not a common occurrence. or Duke University Health System (for medical services, interest, etc. DUKE OF EDINBURGH’S AWARD SCHOOL EXPEDITION BOOKING, MEDICAL & CONSENT FORM This form must be completed and returned to Reach Outdoors Ltd to book your place on a School Expedition. This tracking number is essential if you need to inquire about your requisition. Participant Application Forms. This form is used to receive a valid Vendor Duke ID Badge. Providing both a practice and qualifying adventurous journey, students hike through bushland, coastline and urban environments completing challenges along the way. Permission numbers are used in the registration process to allow faculty to grant permission for students to enroll when the student does not meet a prerequisite, to override a class capacity, or when a class requires permission. Inform participants that you are a researcher from Duke University. I consent to the Award Unit and any other individuals, including Volunteers#, who are involved in or assist in organising The Duke of Ed, and hired transportation drivers, transporting the Participant for the purpose of participating in activities or functions related to The Duke of Ed, as required. February 23, 2021. Completed form must be attached to an Accounts Payable Check Request when requesting payment or it must be attached to a Purchase Requisition when you are requesting a Purchase Order. Duke Health is in compliance with applicable federal and state laws and This form is required when submitting a Corporate Card Application. To submit a request to waive one or more of these coverage's, please complete and submit the Insurance Exception form along with the required documentation. IRS Form W-9, Request For Taxpayer Identification and Certification is used by payers to properly report tax information from miscellaneous payments made to either, Duke University (for grants, contracts, interest, etc.) Registration form - This is the form you need to get started with the Programme. I hereby authorize and consent to be treated by Duke City Primary Care, Inc physicians and staff. IRI transactions show on financial reports with a "JV" reference. 2. Suite 4, Level 3, 189 Kent Street, Sydney 2000, NSW. Skip to … Your child must have entered your email contact information in their ORB before you can submit your consent. Inform participants that you are a researcher from Duke University. Home; ... A student with a GPA lower than 2.7 must use the GPA Waiver Form to obtain permission from his/her academic dean before he/she will be approved for study abroad/away by the Global Education Office for Undergraduates (GEO). Ç7ww (zô�»ÿ>¾¼ûi‹nŞüşŸ»›ïŞı8†^ßß?¾xá¬n={cŞÈŞGkÑö£Õ-EÛ¢ z :::¾tt=èzĞõà׃®‡ü~Ğ{�. The form would be different in the case of focus groups or quantitative research. When preparing consent documents, you should: 1. Consent requests must be clearly distinguishable from the rest of the text of the document or form you use; it needs to be separate from other terms and conditions and easily identifiable as a request for consent. – ‘Green’ Expedition Notification Form (UK expeditions) – Enrolment form for Leaders. Frame Request Form: Purchase customized Duke of Edinburgh's Award frames, formatted to display your Bronze, Silver, or Gold Award certificates. The group will be kayaking on a one way trip, down the Nepean River. Use this version for international services costing greater than $100,000. The Biological Safety Division addresses employee safety, training, policies, and other concerns regarding occupational exposure to biological agents. This form will be shared with any supervisors, assessors that are involved in your expedition. Route Card: This is the form you record your map and compass details for your Adventurous Journey. This form is used for the purchases of services. Find us on Facebook. Contact Us. Home Mobile. If conducting research with vulnerable populations and / or sensitive topics please The Duke of Edinburgh's Award is the world's leading youth achievement award, with over 438,000 young people currently doing their DofE in the UK. This form may be used to Add the Accounts Payable Representative for your department. The Duke University Research Support Services Agreement (RSSA) should be utilized to procure outside services on sponsored codes (20x-28x, A03, and 30x-38x). Find out more. To be completed by the parent/guardian Use this version for domestic services costing greater than $100,000. While it is not standard practice to waive the institutional insurance requirements, Corporate Risk Management may do so when circumstances dictate. © 2014 The Duke of Edinburgh’s International Award Foundation Page 1 of 5 Parent/guardian consent form This form must be completed for applicants under 18 years of age/the national age of legal responsibility in the country in which you live. This form should be used to reinstate a card after suspension. To sign in or register, click here. Dear Parent/Caregiver 5 April 2018 . This resource contains the Office for Civil Rights Consent Form. I understand that the Award Centre will With the implementation of the Health Insurance Portability and Accountability Act (HIPAA), consent forms for all studies that accrue subjects within Duke University Health System must be modified for HIPAA compliance. biological, chemical, radiological) prior to equipment maintenance, transport to Duke Surplus or other destinations. EXCURSION INFORMATION AND CONSENT FORM . The form is used both as a request form and as a priced invoice. You can assign a random number or use your initials and date (ABC5432). The group will be walking from Thornleigh Station to Circular Quay. Duke Human Resources 705 Broad St. Visit us on YouTube. Duke of Ed. Duke Health operations are I agree to my son / daughter / ward doing a DofE programme. An equipment screening form is required when purchasing capital equipment on reportable awards. The Term Sheet for Purchased Services should be utilized when purchasing services on sponsored and non-sponsored funds which cost between $2,500 to $10,000. Handbook – The Duke of Edinburgh’s International Award Australia; Guide for Bronze Award Participants; Guide for Silver Award Participants; Guide for Gold Award Participants They will catch a train to Sign Up Donate Social Media. Consent to Participate in Research. You can also download our Participant App to access the Online Record Book anytime, anywhere. As required by U.S. tax law and IRS regulations, Duke University and Duke University Health System have an obligation to determine if any payments made to a foreign vendor require tax reporting or withholding. Please review and acknowledge. This Rider is required for Domestic RSSA (>$100,000) and International RSSA (>$100,000). Use this version for domestic services costing between $10,001 to $100,000. Please complete both sides thoroughly. This form should be used to reinstate a card after suspension related to untimely postings. Follow us on Twitter. Transform young people’s lives. Transactions that are more than 60 days old are not eligible for dispute. 1300 438 537. The Duke of Edinburgh’s Award Queensland State Award Operating Authority www.dukesaward.qld.gov.au P3 – Medical Consent Form PARTICIPANT CONSENT • I am sufficiently fit to participate in this program. Follow us on Instagram. Once the completed product request has been received, you will receive automatic notices as your request progresses through the PERT process. You should assign a number for tracking purposes. Details of this walk are available on … the current form consenting to the Minor (12-17) Duke MyChart Account. An additional goal of this research is to collect more information on chemical applications in residential furniture over time and within different areas of the United States. Sensitive Consent Forms A consent form that meets the definition of ‘sensitive’ should not be placed in the subject’s medical record unless it is determined to also be ‘clinically relevant’. Yes, enrollment can continue using the currently approved consent form (assuming it is not an expired consent form). Revised 10/06/2006, 11/13/2007, 11/21/2007, 7/10/2013, 10/21/2013. The federal regulations at 45 CFR 46.117(b)(2) and 21 CFR 50.27(b)(2) permit the use of a short form consent document stating that the required elements of informed consent have been presented to the subject or the subject’s legally authorized representative orally, with a witness present. For further clarification on how to use this form, please review the AP Check Request online video tutorial. You are being asked to participate in a research study. Open to all backgrounds, cultures and abilities, a DofE Award can be a game-changer, raising young people’s aspirations and opening doors to employment whilst bringing together communities across the UK. ). Duke of Ed Participant Story Form. Please Note: You will need to register via a web browser first (PC or laptop works best). I hereby authorize and consent to be treated by Duke City Primary Care, Inc physicians and staff. All product requests for trial or purchase must be approved by Duke Medicine's Product and Equipment Review Team (PERT) prior to bringing the product into the hospital. A registration fee of $30 must be sent with the registration form. Further resources are available from the Queensland Award Operating Authority. Box 90496 Durham, NC 27705 Phone: (919) 684-5600 Have questions? Donors may also request a Taxpayer Identification Number to enable them to claim tax deductions for gifts or donations. P4 Adventurous Journey consent form (PDF, 131KB) or —keep the completed form in your personal files; learn about the Adventurous Journey requirements for participants. You should assign a number for tracking purposes. If they are, you can sign up with them straight away. Initial: I confirm that I have correctly completed the online medical and registration form for my daughter/son/ward and have provided all … Do I need to be approved by my Award Leader before I start any Duke of Ed related activities? Learn More. Forms & Policies. PLEASE PRINT THIS FORM AND HAVE IT COMPLETED & SIGNED BY YOUR PARENT OR LEGAL GUARDIAN Please then return this signed document to your School Coordinator to confirm your place. You can also download our Participant App to access the Online Record Book anytime, anywhere. and billing for, care at EXPEDITION CONSENT FORM. Short Form Consent Document. or Duke University Health System (for medical services, interest, etc.). Please read the acknowledgement of risk below and then confirm that you have read and understood the content of the document, agree to the booking terms and … Use this version for international services costing between $10,001 to $100,000. Davis Ambulatory Surgical Center). and I consent to his/her participation in the above Duke of Ed Adventurous Journey. Patient Consent Form … This agreement should be utilized only when a determination is made that the entity is a vendor under the definition in OMB Circular A-133. The Duke Learning Management System (LMS) is used to deliver online training, manage classroom training and the associated learning transcripts for Duke Employees and its affiliates. STATEMENT OF CONSENT "The purpose of this study, procedures to be followed, risks and benefits have been explained to me. Laboratory equipment that needs an evaluation includes, but is not limited to the following: refrigerators, freezers, centrifuges, incubators, chemical fume hoods, biological safety cabinets and other items potentially contaminated with hazardous materials. Route Card: This is the form you record your map and compass details for your Adventurous Journey. Consent Form This service is being conducted by researchers at Duke University to provide more information to the general public on chemical applications in residential furniture. When preparing consent documents, you should: 1. Forms. However, if the revised consent form contains new information that may affect the subject’s willingness to continue (such as additional risks), the IRB may require re-consent as soon as approval of the continuing review is granted. You do not need to submit these to the Queensland Award Operating Authority. send completed form to: ROI-requestor3@dm.duke.edu; Fax: 919-620-5165 OR Duke University Hospital - HIM P.O. My Global Ed: Duke Log-in Non-Duke Log-in. The IRI form is used to order supplies or services from another department. This agreement should be utilized only when a determination is made that the entity is a vendor under the definition in OMB Circular A-133. send completed form to: ROI-requestor3@dm.duke.edu; Fax: 919-620-5165 OR Duke University Hospital - HIM P.O. Name Previous Award Unit. Duke University Form 990 (current and past) Contact ORS: DUNS (Data Universal Numbering System) Number: 044387793: EIN (Federal Employer Identification/Tax Identification) Number: 56-0532129 or 1560532129A1 if prefix and suffix are required: End-User Certificates. number of purposes, including, but not limited to, ensuring that the provision of, – Gold Notification Form – Cymraeg. By Paper - Using the Parent/guardian consent form, you will fill this out and submit … CONSENT - Please read carefully, initial the box and sign at the bottom to give your consent. You can still take part in the research study as described in the consent form document, but you will not be compensated for your participation. Consent form * Email Address I consent to the DofE giving NFER my details from eDofE including name, date of birth, school and personal circumstances (such as gender and ethnicity) so that they can check my educational achievement against the National Pupil Database. United States Department of Education Office for Civil Rights CONSENT FORM - FOR REVEALING NAME AND PERSONAL INFORMATION TO OTHERS Consent Form This service is being conducted by researchers at Duke University to provide more information to the general public on chemical applications in residential furniture. Before you agree to participate, it is important that you have received an oral explanation of this study in a language that is understandable to you. An electronic consent process (eConsent) is allowable on research studies, even for greater-than-minimal-risk studies. Students will begin their journey at Gosford Train Station. The Duke University Research Support Services Agreement (RSSA) should be utilized to procure outside services on sponsored codes (20x-28x, A03, and 30x-38x). I agree to notify the AJS of any changes to my health and fitness, which may occur before, or during the AJ. The submission is not complete until you consent to all 3 forms via an “Accept and Submit” button. "toggle " + jQuery(this).prev().text() + " sub nav", Department Accounts Payable Representative Request Form, Corporate Card Reinstatement Request related to Untimely Postings, PDF - Department Corporate Card Setup Form, XLS - Dept Corporate Card Setup Form w/Instructions, Individual Corporate Cardholder Application, PDF - Individual Corporate Card Application, XLS - Corporate Card Application, Dept Setup Form w/Instructions for both, Statement of Corporate Card Disputed Items, WORKS (BOA) & Fleet Corporate Card Reinstatement, Checklist for Payment to Foreign Vendors (Entities and Individuals), Outside Services Agreement Insurance Exception Request Form, Research Support Services Agreement (Domestic): $10,001 to $100,000, Research Support Services Agreement (Domestic): > $100,000, Research Support Services Agreement (International): $10,001 to $100,000, Research Support Services Agreement (International): > $100,000, RSSA Rider A: Scope of Services, Deliverables & Payment Schedule, RSSA Rider B: Foreign Contract Additional Terms and Conditions, W-9 for Duke Regional Hospital (formerly Durham Regional Hospital), W-9 for Duke University Affiliated Physicians (DUAP). Introduce yourself and invite people to participate in your research. Box 3016 Durham, NC 27710; For Questions Call: 919-684-1700 We are using cookies to give you the best experience on our site. This agreement should be utilized only when a determination is made that the entity is a vendor under the definition in OMB Circular A-133. Supplementary forms. Some service areas have their own form so that they can get additional information needed (for example, Duke Publications Group). This form is used when you are requesting a copy of an accounts payable invoice. IRS Tax Exemption Letters - 501(c)(3) for Duke University and Duke University Health System, Inc. Use this form if you are a nonresident alien individual who is receiving compensation for independent personal services performed in the United States, compensation for dependent personal services performed in the United States, or Non-compensatory scholarship or fellowship income and personal services income from the same withholding agent.