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Sample IRB Application (3)

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ONU IRB APPLICATION_doc_OCTOBER 2010
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: Jane Doe
Email Address: xxx@olivet.edu
Mailing Address: xxxxxxx
Department:
Phone: 555-555-5555
Co-Investigator: n/a
Email Address:
Mailing Address:
Department:
Phone:
3. Title of project: Human Papillomavirus (HPV) Vaccine
5. Has this project previously been considered by the IRB? Yes ____ No__x__
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 ___x___
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__x___

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ONU IRB APPLICATION_doc_OCTOBER 2010
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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:
9. Does this project SOLELY involve analysis of an existing database? Yes ___ No __x__
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.
Please see below.

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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: Jane Doe Email Address: xxx@olivet.edu Mailing Address: xxxxxxx Department: Phone: 555-555-5555 Co-Investigator: n/a Email Address: Mailing Address: Department: Phone: 3. Title of project: Human Papillomavirus (HPV) Vaccine 5. Has this project previously been considered by the IRB? Yes ____ No__x__ 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 ...
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