Submitted by: Submitted by bukhario
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Category: Other Topics
Date Submitted: 03/16/2014 02:57 PM
Project # _______________
Office Use Only
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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...