Irb Proposal

Project # _______________

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Institutional Review Board

Investigator’s Summary Description of Research

Involving the Use of Human Subjects

Please type all information.

Submission date: Check One:

Proposed start-up date: Experimental

Principal Investigator’s Name: Descriptive

Student Investigator’s Name(s):

Project Title:

U.F. College/Program Area:

Funding Agency:

This research is being conducted for:

_____ Undergraduate Course Number:

_____ Graduate Course Number:

_____ Masters Project or Thesis

Principal Investigator Phone #/email: ______________________________________________

Student Research’s Name: ______________________________________________

Student Researcher’s Phone #/email: __________________________________

Note: Before applying for human subjects review, the Masters Project or Thesis proposal must be formally approved by the project or thesis committee, and a copy of the informed consent must accompany this form to the Institutional Review Board (IRB).

I hereby certify that upon approval of this proposal by the IRB, no changes will be made without approval of the IRB, and that any problems, adverse reaction, or unforeseen conditions encountered in the use of human subjects will be immediately reported to the Chair of the IRB. I further agree to supply the IRB with all requested reports and a Certificate of Compliance upon completion of the project.

Principal Investigator’s Signature Date

Student Researcher’s Signature Date

Program Director’s Signature Date

IRB Chair’s Signature Date

Exempt Expedited

The IRB approval of the research project is for a period of one year.

Please provide concise and complete answers for the following areas. If necessary, you may attach extra pages.

1. Project...