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IRB application ONU

IRB application ONU

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ONU IRB APPLICATION_doc_OCTOBER 2010

APPLICATION FOR APPROVAL OF INVESTIGATIONS

INVOLVING THE USE OF HUMAN PARTICIPANTS

PLEASE TYPE OR USE A WORD PROCESSOR

Submit to the Institutional Review Board, by the first working Monday of the month for

screening prior to the IRB meeting. Please add additional space between items as needed

to describe your project.

Your informed consent document(s), survey instrument, and site approval letter(s) should be

attached to the application and referred to in your write up of the appropriate sections so that

reviewers may read them as they read your application. If site approval is dependent on prior

IRB approval, please note that information prominently in section I. B. You must fill out this

application; thesis proposals or other documents that are meant to substitute for completing the

sections of the application will not be read and should not be attached.

You must attach documentation of IRB Training for each investigator (see IRB web site for

more information about training)

1. Principal Investigator's Name:

Email Address:

Mailing Address:

Department:

Phone:

Co-Investigator:

Email Address:

Mailing Address:

Department:

Phone:

2. If you are a student, provide the following information:

Faculty Sponsor:

Department:

Phone:

Faculty Mailing Address:

Student Permanent Address (where you can be reached 12 months from now):

Is this your thesis or dissertation research? Yes _____ No______

3. Title of project:

4. Project Period: Start upon IRB approval End:

month, day, year

Note: Your project period may not start until after the IRB has given final approval.

5. Has this project previously been considered by the IRB? Yes ____ No____

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ONU IRB APPLICATION_doc_OCTOBER 2010

If yes, give approximate date of review:

6. Do you or any other person responsible for the design, conduct, or reporting of this

research have an economic interest in, or act as an officer or a director of, any outside

entity whose financial interests would reasonably appear to be affected by the research?

Yes ______ No ______

If "yes," please include a statement below that may be considered by the Institutional

Review Board:

7. Is a proposal for external support (e.g., a grant) being submitted? Yes____ No_____

If yes, you must submit (as a separate attachment) one complete copy of that proposal as

soon as it is available and complete the following:

a. Is notification of Human Participant approval required? Yes _____ No _____

b. Is this a renewal application? Yes _____ No _____

c. Grantor's Name:

d. Project Period: From: To:

8. You must include copies of all pertinent information such as, a copy of the questionnaire

you will be using or other survey instruments, informed consent documents, letters of

approval from cooperating institutions (e.g., schools, hospitals or other medical facilities

and/or clinics, human services agencies, individuals such as physicians or other

specialists in different fields, etc.), copy of external support proposals, etc.

9. Does this project SOLELY involve analysis of an existing database? Yes ____ No ____

If yes, please provide the complete URLs for all databases that are relevant to this

application, then complete the signature portion of the application and forward the

application to the Institutional Review Board:

If the database is not available in an electronic format readily available on the Internet,

please discuss how the data were or will be collected and what measures have been or

will be taken to protect the identity of the human participants. If this includes procedures

that were reviewed and approved by (another) Institutional Review Board, then provide

documentation, complete the signature portion of the application and forward the

application to Olivet Nazarene University’s Institutional Review Board.

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1 APPLICATION FOR APPROVAL OF INVESTIGATIONS INVOLVING THE USE OF HUMAN PARTICIPANTS PLEASE TYPE OR USE A WORD PROCESSOR Submit to the Institutional Review Board, by the first working Monday of the month for screening prior to the IRB meeting. Please add additional space between items as needed to describe your project. Your informed consent document(s), survey instrument, and site approval letter(s) should be attached to the application and referred to in your write up of the appropriate sections so that reviewers may read them as they read your application. If site approval is dependent on prior IRB approval, please note that information prominently in section I. B. You must fill out this application; thesis proposals or other documents that are meant to substitute for completing the sections of the application will not be read and should not be attached. You must attach documentation of IRB Training for each investigator (see IRB web site for more information about training) 1. Principal Investigator's Name: Email Address: Mailing Address: Department: Phone: Co-Investigator: Email Address: Mailing Address: Department: Phone: 2. If you are a student, provide the following information: Faculty Sponsor: Department: Phone: Faculty Mailing Address: Student Permanent Address (where you can be reached 12 months from now): Is this your thesis or dissertation research? 3. Title of project: 4. Project Period: Start upon IRB approval Yes _____ No______ End: month, day, ...
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