IRB : Informed Consent Form Creator

Informed Consent Form Creator

Principal Investigator

Please make sure you have filled in all required fields with valid information.

Project Title:

First Name:

Last Name:

Phone:

- -

Email Address:

This Project has a Co-Investigator

I am a faculty member.

Co-Investigator

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First Name (Co-Investigator):

Last Name (Co-Investigator):

Phone (Co-Investigator):

- -

Email Address (Co-Investigator):

Add more Co-Investigators

Co-Investigators:

Please separate multiple names with a comma.

Faculty Sponsor Information

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Faculty Sponsor First Name:

Faculty Sponsor Last Name:

Faculty Sponsor Phone Number:

- -

Faculty Sponsor Email Address:

Research Information

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Type of Research

Type of Research:

Other Research Type:

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

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

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?

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?

Explanation of Recording:

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

Name of Building:

Room Number:

Other Storage Location:

Additional Confidentiality Procedures:

When Will Records Be Destroyed?

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?

Amount of Compensation (in dollars):

Form of Compensation:

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

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Informed Consent Form Creator

IRB

Additional Contact Information

Informed Consent Form Creator

Type of Research

Purpose of Research

Description of Procedures

Experimental Medical Treatments

Risks

Benefits

Confidentiality

Compensation