Sponsored Programs - Institutional Review Board Application Form

(For best results, please fill out this form using the Google Chrome Browser.)

Submit only the application along with any supplemental documents (uploaded into the application) to the IRB. Do not submit your proposal.

This application form will automatically be sent to the IRB Chair.

The data in this form is not savable, so we highly recommend you review the questions below, then type your answers into a Word document so you may copy and paste them into the form below.

Application Contact Information

Project Information

Project Type *

For the following question on Methodology, please answer: What tasks will participants be asked to perform? Include a step-by-step description of the procedures you will use with participants and the location of your research.

For the following question on Instruments and Materials, please answer: Describe what instruments will be used, include the frequency and method of delivery (online surveys, face-to-face interview, in-person surveys, etc.). Also include a copy of the instruments with this application.

Participants

Will the participants encounter the possibility of any risks which are greater, in probability or magnitude, than those ordinarily encountered in daily life or during the performance of routine physical or psychological examinations or tests? ? (Check all that apply) *

Participant Recruitment Procedures

For the following question on Potential Benefits, please explain the potential benefits of this research to the participants, the group that made them participant candidates (low-income, gender, history of substance abuse, etc.), and society in general.

Describe each, if any, manipulation to be included within the study.

Will medical clearance be necessary before participants can participate due to tissue or blood sampling, or administration of substances such as food or drugs, or physical exercise conditioning?

Medical Clearance Needed? *

Will there be a request for information that participants might consider to be personal or sensitive?

Personal/Sensitive Info Requests *

Will any inducements be offered to the participants for their participation?

Inducements? *

If extra course credit is offered, what alternative means of obtaining additional credit are available?

Will any aspect of the data be made a part of any record that can be identified with the participant?

Can the participant be identified in records? *

Explain your procedures for secure collection and storage of consent forms, if applicable, and data including how long the forms will be kept and when they will be destroyed (shredded). Please be thorough to protect the study participants. When creating your procedures, approach it as if the potentially sensitive information is yours.

Will the fact that a participant did or did not participate in a specific experiment or study be made a part of any record available to supervisor, teacher, guardian or employer?

Participation/non-participation record available? *
By signing this form electronically, you agree that your advisor has approved your application for IRB submission.

 Clicking this box serves as your electronic signature

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