IRB

Type of Research

Type of Research:

--Please Select-- Doctoral Dissertation Master's Thesis Class Project Faculty-Directed Research Other (Please Specify)

Other Research Type:

Would participants be receiving care from researchers or have they received care in the past?

--Please Select-- Yes No

Would participants be students in a researcher’s class or have they been students in the past?

--Please Select-- Yes No

Purpose of Research

Purpose of Study is to:

Description of Procedures

Description of Procedures:

Length of Time Participation Will Take:

Experimental Medical Treatments

Are There Any Experimental Medical Treatments?

--Please Select-- Yes No

Description of Experimental Medical Treatment Procedures:

Risks

What are the risks?

Person/Organization that participant can contact if upset:

Benefits

What are the benefits to the participant?

If there are no direct benefits, state: There is no direct benefit to participants.

What are the benefits to society?

Confidentiality

Will the session be recorded?

--Please Select-- Yes No

Explanation of Recording:

Location of Record Storage:
(control-click to select multiple)

Locked Filing Cabinet Locked Office Encrypted File Password Protected File/Computer Other

Name of Building:

Room Number:

Other Storage Location:

When Will Records Be Destroyed?

--Please Select-- Three Years After Study Completion A specific number of years after study completion After manuscript development, but no less than three years

Number of Years:

Are you working with any of the following:

Identifiable Information
Biospecimens

Select one statement:

Identifiers might be removed from the and after removal, the may be used for future research studies or distributed to another investigator for future research studies without additional informed consent from you or the legally authorized representative.
Your will not be used or distributed for future research studies.

Compensation

Will participants receive compensation?

--Please Select-- Yes No

Amount of Compensation (in dollars):

Form of Compensation:

For any questions about research studies, call the ORSP at 610-436-3557.