IRB ApplicationReview Application for Research with Human Subjects January 18, 2017 Be sure to attach any questionnaires and consent forms and other supplemental information to ensure your application gets processed in a timely manner. This application is for (check one): EXEMPT from Review (see required documentation on page 4, POLICY booklet) EXPEDITED Review FULL Review E-mail address of principal investigator (student name if student lead research): Telephone: Project Title: This project is being concluded as (check one): Student Project Faculty Supervisor email address: Telephone: Course Title (if appropriate): Department: Course No.: Independent Research Faculty Research Administrative Research This project is being funded by (if applicable): DIRECTIONS In considering applications, the committee will want to see the following issues addressed in a brief (e.g., 1-2 page) statement attached to this Application. The Committee's general concern is the safety and well being (both physical and psychological) of human subjects in research. Failure to answer all questions can result in the proposal being returned to you for further information. Please allow at least two weeks for review. A member of the Review Committee will contact you with a decision in writing. Do no collect data prior to this time. The application number you will be given must appear on all documents such as survey forms, reports, and summaries related to this research project. Please type/computer print your responses. 1.) What is the purpose of the study? Please provide a brief description of the hypothesis and issues under consideration. 2.) What subject group(s) will you work with, and how will you recruit them? 3.) What information will you offer subjects about your study before they participate? (E.g., how will the study be described, what incentives will be offered?) Except in special circumstances (which you must describe and justify), potential subjects should be given enough information about the project to make an informed decision about whether or not to participate. Subjects should not be coerced or pressured, and should be told that they are free to withdraw from participation at any time. 4.) Does the study involve children or others for whom additional consent will be necessary? If so, how will you obtain this consent? (Note: Research involving children normally requires written permission from parents or guardians, in addition to written permission from a school principal or other institutional director, if applicable. Describe how you will seek this permission, attaching copies of proposed permission/consent forms where appropriate.) 5.) How will you plan to protect the privacy and/or anonymity of your subjects, and the anonymity of the data at the conclusion of the study? Please specify how you will destroy the data. If you do not intend to destroy the data, how will it be stored and protected? 6.) Does the study involve deception? If so, explain why deception is necessary and how you will address any potentially harmful consequences. 7.) What are you experimental procedures? Are there any potentially harmful effects that might occur in your study? If so, what are they, and how will you guard against them or seek to minimize them? 8.) If appropriate, how will you debrief your subjects after their work is completed? 9.) Please attach a copy of any survey, questionnaire and/or consent form(s) you plan to use.