Application

Date*

Principal Investigator*

If Principal Investigator is a student, who is the Faculty sponsor?*

Institutional Affiliation*

Email address*

Phone Number*

Mailing Address*

Title of the Study*

Please list all additional researchers who will be involved in the study (include name and institution)*

Who will your potential subjects be? Please check all of the subject populations that will be involved in the research project: *

Describe*

Federal guidelines state that research cannot exclude any classes of subjects without scientific justification. Will your study purposely exclude any classes of subjects (e.g. by gender, class, race or age)? *

Yes

If yes, please justify:*

Will subjects be compensated for their participation?*

Yes

If yes, please describe. [PLEASE NOTE: If using a lottery system, please remember to state odds of winning in consent form]*

Will deception be used? *

Yes

If yes, please provide a rationale for its use. How will subjects be debriefed afterward? Submit debriefing script. Scripts should include a statement that gives your subjects the opportunity to withdraw their participation at that time. [PLEASE NOTE: studies involving deception are given Full Board Review unless the deception is minor and risks are minimal].*

Will data be collected anonymously? *

Yes

If no, will you be able to link the data? How will subjects’ confidentiality be protected? (e.g. codes, pseudonyms, masking of information)? *

Please describe the plan of the research which includes *

a) the purpose of your study including scientific justification. Include citations as appropriate
b) your research question and hypothesis
c) the study methodology including what activities subjects will be engaged in and how long it will take them
d) the number of subjects you plan to recruit and the anticipated age range, gender, race/ethnicity (if applicable) and/or any other important characteristics of your subjects
e) from where and how the subjects will be recruited
f) the sample size of the study, and the projected number of subjects that will be recruited to achieve that sample size
g) where the study will take place (e.g., classroom, office, other location)
h) Potential risks to subjects. What are the potential risks, if any, (physical, psychological, social, legal, or other) to your subjects? What is the likelihood of these risks occurring, and/or their seriousness? How will you work to minimize them? [PLEASE NOTE: The IRB regards no research involving human subjects as risk-free. You must describe minimal risks for your study (such as discomfort, boredom, fatigue, etc.), or state that the research will involve minimal risk, similar to an activity that you name that participants commonly engage in in every day life.]
i) What are the potential benefits of this study to the subjects and to the community? If there are direct benefits, please describe. If there are no direct benefits, please simply state this. You may note benefits that may be possible from your research, but you cannot promise a result of your study as being a benefit. Remuneration or any incentive or reward for participation is not considered a benefit.
j) Where will data materials be stored (e.g. ‘in a locked file cabinet in the Principal Investigator’s home or office’)?
k) What procedures will be used for obtaining subjects’ informed consent to participate in the research?

Please attach (as applicable): *

1) Plan of research (see above)
2) Consent forms
3) Debriefing scripts
4) Documentation of IRB approval from collaborating institutions
5) Recruitment flyers, emails, scripts, advertisements
6) Survey/interview instruments

This field should be left blank

Institutional Review Board Application

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