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Institutional Review Board Application
FOR HUMAN SUBJECTS Research
The University of Phoenix Institutional Review Board (IRB XE
"IRB" ) exists to ensure university compliance with federal
regulations regarding research involving human subjects. This
application is used to facilitate and document this compliance
review. Research projects which meet the federal definition for
research and the federal definition of human subjects must be
approved by the University of Phoenix IRB before any data
collection begins. If an IRB application is approved by the IRB
and, later, the nature of the research design, requirements, or
site locations change, a revised application describing these
changes must be submitted for reconsideration and approval by
the IRB. This application is intended as a stand alone
document, so reference to other documents or appendices of
dissertation proposals or other research studies does not
substitute for direct provision of that information as part of this
application, either as a response within a section or as an
addendum. This application pertains to both pilot studies and
full studies. Please note that it is the researcher’s responsibility
to give complete and accurate information about the nature of
the proposed study, particularly in terms of the effects on, and
expectations for, subject participants. Please note that you must
document currency in CITI certification as part of this
application.
Name of Researcher(s)
City, State, and Country / School or College and University
Affiliation
(student, faculty, or staff and id)
Type of Research
(research study, *funded research, or other)
[city/state]
[college]
University of Phoenix
IRN: LEAVE THIS BLANK
* If research is funded, please complete the following agency
information. Otherwise, leave blank.
agency submitted to
submission date
location of project
/ /
1. Title of the Research Study/Dissertation:
2. Classification of the Study:
a) Will primary data collection from human subjects be done in
this study?
( FORMCHECKBOX
) Yes, original data only is collected from human subjects and
no archival data will be used.
( FORMCHECKBOX
) Yes, both original data from human subjects and archival data
will be collected and used.
( FORMCHECKBOX
) No, only archival data will be used.
b) Are the research study results generalizable or relevant to a
larger population or only relevant to one
organization or entity?
( FORMCHECKBOX
) Results are generalizable to a larger population.
( FORMCHECKBOX
) Results are relevant only to one organization or entity.
3. Purpose and Anticipated Study Goal(s) and Benefits:
Briefly describe the following:
The purpose of the study:
The anticipated study goal(s):
The benefits of the study to the subjects, to the organization,
and to society:
3.1 Data Usage and Ownership: If your research involves
access to, and/or use of, a pre-existing private or restricted
database (one that is not open access/publically available),
please briefly describe the type of data in the database, the
organization or individual owner or controller of the data, how
the data will be accessed and how data confidentiality will be
ensured.
a) Does this research study involve access to, or use of public,
open access databases or
datasets, resources, recruitment lists, contact
information for potential subjects or any other pre-
existing public data? (Note that “open access” means
free and available to the general public without
restriction or prior permission needed.)
( FORMCHECKBOX
) No ( FORMCHECKBOX
) Yes (Please describe here)
b) Does this research study involve access to, or use of
private databases or datasets, private resources or
recruitment lists, contact information for potential
subjects or any other pre-existing private data?
( FORMCHECKBOX
) No ( FORMCHECKBOX
) Yes (Please describe here and document permission granted
for access and
use)
c) During data collection or subject recruitment, will
access be needed to any health information created,
received or archived by health care providers,
clearinghouses, or health care plans that pertains to the
past, present or future health conditions or provision of
health care to an individual living or deceased?
( FORMCHECKBOX
) Yes ( FORMCHECKBOX
) No
( FORMCHECKBOX
) HIPAA compliance (if health records are used, please discuss
here and address HIPAA compliance)
d) Will school or student related data be collected in this
study?
( FORMCHECKBOX
) Yes, individual student data ( FORMCHECKBOX
) Yes, aggregate student data ( FORMCHECKBOX
) No
( FORMCHECKBOX
) FERPA compliance (if student data is used, please explain
here and address FERPA compliance)
4. Project Description: Briefly explain and address the
following questions as indicated:
a) Who are the subjects of this study and where are they
located? (for example, lawyers in private practice in the State of
Ohio)
b) What are the subjects expected to do as participants in
this study and what is the time commitment involved? Please
explain. If class time is used, please describe the activities
planned for non-participants.
c) Will a pilot study be conducted before the primary data
collection occurs? ( FORMCHECKBOX
) No ( FORMCHECKBOX
) Yes
d) What is the research method and design? Check all that
apply:
( FORMCHECKBOX
) quantitative analysis ( FORMCHECKBOX
) qualitative analysis ( FORMCHECKBOX
) mixed methods
( FORMCHECKBOX
) phenomenological ( FORMCHECKBOX
) case study ( FORMCHECKBOX
) experimental ( FORMCHECKBOX
) quasi experimental ( FORMCHECKBOX
) Delphi
( FORMCHECKBOX
) other (specify)
___________________________________________
e) How will data be collected? Check any that apply:
( FORMCHECKBOX
) face to face interview ( FORMCHECKBOX
) focus group ( FORMCHECKBOX
) online survey ( FORMCHECKBOX
) mail survey ( FORMCHECKBOX
) telephone survey
( FORMCHECKBOX
) onsite survey ( FORMCHECKBOX
) email survey ( FORMCHECKBOX
) Skype or related technology
( FORMCHECKBOX
) other (specify) ____________________________
f) Where will data collection occur? Check any that apply
and specify the location(s) below.
( FORMCHECKBOX
) organizational site ( FORMCHECKBOX
) online ( FORMCHECKBOX
) private premises ( FORMCHECKBOX
) public facility ( FORMCHECKBOX
) open access site
( FORMCHECKBOX
) other ( FORMCHECKBOX
) not applicable
Location
__________________________________________
g) What is the degree or magnitude of risk/stress (physical,
psychological, emotional, legal, financial) to the
human subjects because of their participation in this
study?
( FORMCHECKBOX
) minimal risk/stress, not greater than encountered in ordinary
daily life/activities or routine tests.
( FORMCHECKBOX
) greater than minimal risk/stress with potential for direct
benefit to the individual subjects
( FORMCHECKBOX
) greater than minimal risk/stress with little/no potential direct
benefit to individual subjects
h) If greater than minimal risk/stress to the human subject is
possible, please explain how the risk/stress will be mitigated or
lessened.
i) Are any third parties assisting with this study that will
have access to the data?
( FORMCHECKBOX
) No ( FORMCHECKBOX
) Yes (specify) ______________________________________
j) Will any aspect of the study take place outside of the
United States?
( FORMCHECKBOX
) No ( FORMCHECKBOX
) Yes (specify where)
_______________________________________
Note that IRB approval may be needed in the country
where research is taking place.
PLEASE PROVIDE HERE (OR AS AN ADDENDUM
TO THIS APPLICATION) ANY ADDITIONAL
INFORMATION
OR EXPLANATION THAT YOU THINK MAY BE
HELPFUL TO THE IRB REGARDING YOUR RESEARCH
STUDY
DESIGN OR IMPLEMENTATION.
5. Subject Groups: Will the subjects recruited to participate in
this study include any that are in protected groups identified
below as specified within the federal human subject guidelines?
(The guidelines are defined at www.citiprogram.org)
If any category from this list is checked “yes”, please
explain in the “Comments” area below how the subjects will be
protected from harm, risk, or stress as a study participant and
how stress/risk will be mitigated or lessened.
a. Children/minors under age 18?
Yes ( FORMCHECKBOX
)
No ( FORMCHECKBOX
)
b. Prisoners?
Yes ( FORMCHECKBOX
)
No ( FORMCHECKBOX
)
c. Pregnant women?
Yes ( FORMCHECKBOX
)
No ( FORMCHECKBOX
)
d. Cognitively impaired or mentally
disabled?
Yes ( FORMCHECKBOX
)
No ( FORMCHECKBOX
)
e. Educationally or economically
disadvantaged?
Yes ( FORMCHECKBOX
)
No ( FORMCHECKBOX
)
Will the subjects be traumatized, comatose, or terminally ill
patients?
Yes ( FORMCHECKBOX
)
No ( FORMCHECKBOX
)
Will the subjects be elderly or aged persons?
Yes ( FORMCHECKBOX
)
No ( FORMCHECKBOX
)
Will the subjects be minorities (including women)?
Yes ( FORMCHECKBOX
)
No ( FORMCHECKBOX
)
Will information be withheld from subjects prior to, or during,
participation?
Yes ( FORMCHECKBOX
)
No ( FORMCHECKBOX
)
Will the subjects be college students?
Yes ( FORMCHECKBOX
)
No ( FORMCHECKBOX
)
Will the subjects be deceived, misled, or coerced in any way?
Yes ( FORMCHECKBOX
)
No ( FORMCHECKBOX
)
Will/might the subjects be students of the University of
Phoenix?
Yes ( FORMCHECKBOX
)
No ( FORMCHECKBOX
)
Will/might the subjects be faculty or staff of the University of
Phoenix?
Yes ( FORMCHECKBOX
)
No ( FORMCHECKBOX
)
Will information be requested that is, or may be, personal or
sensitive?
Yes ( FORMCHECKBOX
)
No ( FORMCHECKBOX
)
If the subjects are active duty military, will their supervisors
have influence on their participation in this research or will
participation be affected at all by the reporting relationship(s)?
Yes ( FORMCHECKBOX
)
No ( FORMCHECKBOX
)
Will any aspect of this study involve subjects from countries
outside of the U.S.? If yes, please specify in the comments
section below.
Yes ( FORMCHECKBOX
)
No ( FORMCHECKBOX
)
Comments:
6. Subject Recruitment and Selection: Briefly explain and
address the following:
a) Which of the following will be used to find and recruit
subjects? (check all that apply and include copies with
this application)
( FORMCHECKBOX
) Flyers (
FORMCHECKBOX
) Email Announcement
( FORMCHECKBOX
) Events, Meetings, Conferences ( FORMCHECKBOX
) Area Canvassing
( FORMCHECKBOX
) Phone Solicitation (
FORMCHECKBOX
) Registry
( FORMCHECKBOX
) Newspaper/Radio/Television ( FORMCHECKBOX
) Referrals from Others
( FORMCHECKBOX
) Institutional “gatekeepers” ( FORMCHECKBOX
) Direct Mail
( FORMCHECKBOX
) Face to Face Interaction ( FORMCHECKBOX
) Internet/Websites
( FORMCHECKBOX
) Bulletin Board Post (
FORMCHECKBOX
) Social Media (e.g. LinkedIn, Facebook, etc.) (please specify
( FORMCHECKBOX
) Poster
below; documented use permission is required)
(
FORMCHECKBOX
) PhoenixConnect (please note if this is used,
separate prior approval through the UOPX
Committee on Research must be documented)
( FORMCHECKBOX
) Other (please
specify)____________________________________________
EXPLAIN AND DESCRIBE HERE IF SOCIAL MEDIA
WILL BE USED ____________________________________
b) What is the anticipated sample size?
( FORMCHECKBOX
) 10 or less ( FORMCHECKBOX
) 11-20 ( FORMCHECKBOX
) 21-50 ( FORMCHECKBOX
) 51-99 ( FORMCHECKBOX
) 100-199 ( FORMCHECKBOX
) 200 or more
c) Will any external parties (such as editors, translators,
interpreters, statisticians, etc.) provide assistance for
recruitment purposes? (This does not pertain to persons
who assist recruitment by “snowball sampling”.)
( FORMCHECKBOX
) No ( FORMCHECKBOX
) Yes (please identify and explain how they will assist)
_____________________________
d) Are any of the research subjects students, employees, or
patients of the researcher?
( FORMCHECKBOX
) Yes ( FORMCHECKBOX
) No
e) If any potential subjects under the age of 18 years are not
selected to participate in this study, what activities
will they be doing during the time the subjects are
participating in the study so that they do not feel excluded
or left out? If this scenario does not pertain to the study,
please indicate “Not applicable” here.
f) Please briefly describe the criteria that will be used to
determine the inclusion or exclusion of subjects for
this study.
g) Will any compensation or remuneration be given to
subjects for their participation in this study?
( FORMCHECKBOX
) No ( FORMCHECKBOX
) Yes (please identify amount and type, and the plan for
dissemination.
PLEASE PROVIDE HERE (OR AS AN ADDENDUM TO
THIS APPLICATION) ANY ADDITIONAL INFORMATION
OR EXPLANATION CONCERNING THE ABOVE
QUESTIONS THAT YOU THINK MAY BE HELPFUL TO THE
IRB REGARDING THE RECRUITMENT OF SUBJECTS FOR
YOUR RESEARCH STUDY.
7. Informed Consent: Briefly explain and address the
following questions.
a) How will subjects be informed of the study’s purpose,
procedures, intent, duration of the study and any
potential risks or discomforts to them? Check all that
apply:
( FORMCHECKBOX
) Informed Consent form ( FORMCHECKBOX
) Email ( FORMCHECKBOX
) Letter ( FORMCHECKBOX
) Meeting ( FORMCHECKBOX
) Phone Call ( FORMCHECKBOX
) Other _______
b) How will subjects be informed of withdrawal
procedures? Check all that apply:
( FORMCHECKBOX
) Informed Consent form ( FORMCHECKBOX
) Email ( FORMCHECKBOX
) Letter ( FORMCHECKBOX
) Meeting ( FORMCHECKBOX
) Phone Call ( FORMCHECKBOX
) Other _______
c) How will the researcher contact information be provided
to the subjects? Check all that apply:
( FORMCHECKBOX
) Informed Consent form ( FORMCHECKBOX
) Email ( FORMCHECKBOX
) Letter ( FORMCHECKBOX
) Meeting ( FORMCHECKBOX
) Phone Call ( FORMCHECKBOX
) Other _______
d) How will subjects withdraw from the study as
participants after data collection is completed?
( FORMCHECKBOX
) Email the researcher ( FORMCHECKBOX
) Phone call to researcher ( FORMCHECKBOX
) Submit withdrawal form
( FORMCHECKBOX
) Other (please specify)
_____________________________________________________
______
e) Please explain what subjects must do to withdraw from
the study after data is collected and how subject data
will be retrieved and handled to ensure security and
confidentiality.
f) If any subjects are under the age of 18 years, parental
consent is required. What provision is made to
answer any questions the parents have about this study or
to address any individual concerns? (For example,
will there be an informational meeting with the parents,
etc.?) If this scenario does not apply to this study,
please indicate “Not applicable” here.
PLEASE PROVIDE HERE (OR AS AN ADDENDUM TO
THIS APPLICATION) ANY ADDITIONAL INFORMATION
OR EXPLANATION THAT YOU THINK MAY BE
HELPFUL TO THE IRB REGARDING ANY OF THE ABOVE
QUESTIONS OR ABOUT THE INFORMED CONSENT
FOR YOUR RESEARCH STUDY.
PLEASE READ AND CONFIRM THROUGH CHECK
MARKING THE BOXES BELOW:
FORMCHECKBOX
I attest that no primary data collection from human subjects
will occur without a prior signed Informed
Consent form completed for each subject and that
Informed Consent documentation will be retained
separately from study data.
FORMCHECKBOX
I attest that a process for subject withdrawal will be
implemented whereby subjects may withdraw without
penalty before, during and after data collection has
been completed and submitted and that the
information they provided will be identified, secured,
withdrawn and kept confidential.
8. Confidentiality and Privacy: Briefly explain and address
how the identity and privacy of the individual subjects will be
protected. Check any of the following that apply:
a) How will subject identity and data be protected?
( FORMCHECKBOX
) Subject names will not be used or identified
( FORMCHECKBOX
) Pseudonyms or numbers will be used instead of subject
names
( FORMCHECKBOX
) Data will be coded alphanumerically
( FORMCHECKBOX
) Other (please specify)
________________________________________________
b) Will any audio and/or video tape or other recording of
data be done in this study?
( FORMCHECKBOX
) Yes ( FORMCHECKBOX
) No
c) How long will the study data be kept after study
completion?
( FORMCHECKBOX
) Three years (please note this is the minimum required
retention time)
( FORMCHECKBOX
) More than three years
d) Where will the data be stored:
( FORMCHECKBOX
) In an office or other location at the researcher’s residence
( FORMCHECKBOX
) At an office at the researcher’s place of employment
( FORMCHECKBOX
) At a third party facility (please specify)
________________________________
( FORMCHECKBOX
) Other (please specify)
______________________________________________
e) How will data be destroyed at the appropriate time?
( FORMCHECKBOX
) Shredding ( FORMCHECKBOX
) Burning or incineration ( FORMCHECKBOX
) Smashing ( FORMCHECKBOX
) File Deletion
( FORMCHECKBOX
) Other (please specify)
______________________________________________
f) How will the results of this study be disseminated?
( FORMCHECKBOX
) Publication ( FORMCHECKBOX
) Presentation ( FORMCHECKBOX
) Other _____________________________
PLEASE PROVIDE HERE (OR AS AN ADDENDUM TO
THIS APPLICATION) ANY ADDITIONAL INFORMATION
OR EXPLANATION CONCERNING THE ABOVE THAT YOU
THINK MAY BE HELPFUL TO THE IRB REGARDING
CONFIDENTIALITY AND PRIVACY CONCERNS
ASSOCIATED WITH YOUR RESEARCH STUDY.
PLEASE READ AND CONFIRM THROUGH CHECK
MARKING THE BOX BELOW:
FORMCHECKBOX
I attest that the data from this research will be kept in a
secured location for at least three years following
study completion, and then will be permanently
destroyed.
PAGE
Current version 032012
6
Title
ABC/123 Version X
1
1Experimental Designs WorksheetFill in the Blank
Using the terms listed below, complete the following:
1. ___________ group receives treatment in an experimental
design.
2. ___________ group does not receive treatment in an
experimental design.
3. A ___________ design has many observations on a single
case or a few subjects.
4. When separate groups of subjects receive different levels of
the independent variable, this is referred to as _____________
design.
5. When all subjects receive all levels of the independent
variable, this is referred to as ____________ design.
6. When the researcher measures a behavior that needs to be
changed and then applies therapy and measures the behavior
again, this is referred to as _____________ design.
7. When the researcher measures a behavior that needs to be
changed, applies therapy and measures the behavior again, and
then removes the treatment and measures the behavior again,
this is referred to as ______________ design.
8. When the criterion outcome changes over time this is referred
to as _______________ design.
9. When measuring several behaviors or several people with
baseline periods of varying lengths and an independent variable
occurs, this is referred to as a ______________ design.
10. When subjects are not randomly assigned and not all
variables are under the control of the presenter, this is referred
to as ______________ design.
A. Multiple Baseline
B. Small n
C. AB
D. Control
E. Experimental
F. ABA
G. Between Subject
H. Quasi-Experimental
I. Changing Criterion
J. Within Subject
Matching
Read the following scenarios and match each scenario with the
correct type of experimental design.
1. _____ Two classes of children are studied regarding the
effects of a new teaching method in science. One group
received the new method of instruction, while the other group
uses the standard, traditional method of instruction. Both
classes are measures for achievement before and after the
teaching methods.
2. _____ Divide your subjects in half. One group receives one
treatment of the independent variable and the other group
receives a different treatment of the independent variable.
Subjects were all told they were going to see a video of a
therapist's session after which they would rate the quality of the
session. The groups differed in that the subjects in one group
were told that prior evaluations indicated that the therapist was
effective whereas subjects in the other group were told that the
evaluations indicated the therapist was not effective. These
different subjects were used for the two levels of the
independent variable: subjects were in either the "effective
therapist" or the "ineffective therapist" condition.
3. _____ All subjects perform at all levels of the independent
variable. Subjects diagnosed as having attention deficit
disorder were each tested on a concentration task after receiving
medication. All subjects were tested four times, once after
receiving one of the four doses. Each subject was tested under
each of the four levels of the independent variable-dose of
medication.
4. _____ A small group is measured for the amount of anxiety
they experience in math class (baseline). They are taught a
relaxation method and measured again to measure anxiety in
math class.
5. _____ To study verbal commands in canines, during week 1
the baseline is recorded for how many times a dog chased a cat.
During week 2, dog was verbally scolded (treatment) when the
dog chased the cat, and the chasing behavior was recorded.
During week 3, the chasing behavior was recorded without the
verbal scolding (treatment).
A. Between-Subjects Design
B. AB Design
C. Quasi-Experimental Design
D. ABA Design
E. Within-Subjects Design
Copyright © XXXX by University of Phoenix. All rights
reserved.

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  • 1. Institutional Review Board Application FOR HUMAN SUBJECTS Research The University of Phoenix Institutional Review Board (IRB XE "IRB" ) exists to ensure university compliance with federal regulations regarding research involving human subjects. This application is used to facilitate and document this compliance review. Research projects which meet the federal definition for research and the federal definition of human subjects must be approved by the University of Phoenix IRB before any data collection begins. If an IRB application is approved by the IRB and, later, the nature of the research design, requirements, or site locations change, a revised application describing these changes must be submitted for reconsideration and approval by the IRB. This application is intended as a stand alone document, so reference to other documents or appendices of dissertation proposals or other research studies does not substitute for direct provision of that information as part of this application, either as a response within a section or as an addendum. This application pertains to both pilot studies and full studies. Please note that it is the researcher’s responsibility to give complete and accurate information about the nature of the proposed study, particularly in terms of the effects on, and expectations for, subject participants. Please note that you must document currency in CITI certification as part of this application. Name of Researcher(s) City, State, and Country / School or College and University Affiliation (student, faculty, or staff and id) Type of Research
  • 2. (research study, *funded research, or other) [city/state] [college] University of Phoenix IRN: LEAVE THIS BLANK * If research is funded, please complete the following agency information. Otherwise, leave blank. agency submitted to submission date location of project / / 1. Title of the Research Study/Dissertation: 2. Classification of the Study: a) Will primary data collection from human subjects be done in this study? ( FORMCHECKBOX ) Yes, original data only is collected from human subjects and no archival data will be used. ( FORMCHECKBOX ) Yes, both original data from human subjects and archival data will be collected and used. ( FORMCHECKBOX ) No, only archival data will be used. b) Are the research study results generalizable or relevant to a larger population or only relevant to one organization or entity?
  • 3. ( FORMCHECKBOX ) Results are generalizable to a larger population. ( FORMCHECKBOX ) Results are relevant only to one organization or entity. 3. Purpose and Anticipated Study Goal(s) and Benefits: Briefly describe the following: The purpose of the study: The anticipated study goal(s): The benefits of the study to the subjects, to the organization, and to society: 3.1 Data Usage and Ownership: If your research involves access to, and/or use of, a pre-existing private or restricted database (one that is not open access/publically available), please briefly describe the type of data in the database, the organization or individual owner or controller of the data, how the data will be accessed and how data confidentiality will be ensured. a) Does this research study involve access to, or use of public, open access databases or datasets, resources, recruitment lists, contact information for potential subjects or any other pre- existing public data? (Note that “open access” means free and available to the general public without restriction or prior permission needed.) ( FORMCHECKBOX ) No ( FORMCHECKBOX ) Yes (Please describe here) b) Does this research study involve access to, or use of private databases or datasets, private resources or
  • 4. recruitment lists, contact information for potential subjects or any other pre-existing private data? ( FORMCHECKBOX ) No ( FORMCHECKBOX ) Yes (Please describe here and document permission granted for access and use) c) During data collection or subject recruitment, will access be needed to any health information created, received or archived by health care providers, clearinghouses, or health care plans that pertains to the past, present or future health conditions or provision of health care to an individual living or deceased? ( FORMCHECKBOX ) Yes ( FORMCHECKBOX ) No ( FORMCHECKBOX ) HIPAA compliance (if health records are used, please discuss here and address HIPAA compliance) d) Will school or student related data be collected in this study? ( FORMCHECKBOX ) Yes, individual student data ( FORMCHECKBOX ) Yes, aggregate student data ( FORMCHECKBOX ) No ( FORMCHECKBOX ) FERPA compliance (if student data is used, please explain here and address FERPA compliance) 4. Project Description: Briefly explain and address the following questions as indicated: a) Who are the subjects of this study and where are they located? (for example, lawyers in private practice in the State of
  • 5. Ohio) b) What are the subjects expected to do as participants in this study and what is the time commitment involved? Please explain. If class time is used, please describe the activities planned for non-participants. c) Will a pilot study be conducted before the primary data collection occurs? ( FORMCHECKBOX ) No ( FORMCHECKBOX ) Yes d) What is the research method and design? Check all that apply: ( FORMCHECKBOX ) quantitative analysis ( FORMCHECKBOX ) qualitative analysis ( FORMCHECKBOX ) mixed methods ( FORMCHECKBOX ) phenomenological ( FORMCHECKBOX ) case study ( FORMCHECKBOX ) experimental ( FORMCHECKBOX ) quasi experimental ( FORMCHECKBOX ) Delphi ( FORMCHECKBOX ) other (specify) ___________________________________________ e) How will data be collected? Check any that apply: ( FORMCHECKBOX ) face to face interview ( FORMCHECKBOX ) focus group ( FORMCHECKBOX ) online survey ( FORMCHECKBOX ) mail survey ( FORMCHECKBOX ) telephone survey ( FORMCHECKBOX ) onsite survey ( FORMCHECKBOX
  • 6. ) email survey ( FORMCHECKBOX ) Skype or related technology ( FORMCHECKBOX ) other (specify) ____________________________ f) Where will data collection occur? Check any that apply and specify the location(s) below. ( FORMCHECKBOX ) organizational site ( FORMCHECKBOX ) online ( FORMCHECKBOX ) private premises ( FORMCHECKBOX ) public facility ( FORMCHECKBOX ) open access site ( FORMCHECKBOX ) other ( FORMCHECKBOX ) not applicable Location __________________________________________ g) What is the degree or magnitude of risk/stress (physical, psychological, emotional, legal, financial) to the human subjects because of their participation in this study? ( FORMCHECKBOX ) minimal risk/stress, not greater than encountered in ordinary daily life/activities or routine tests. ( FORMCHECKBOX ) greater than minimal risk/stress with potential for direct benefit to the individual subjects ( FORMCHECKBOX ) greater than minimal risk/stress with little/no potential direct benefit to individual subjects h) If greater than minimal risk/stress to the human subject is possible, please explain how the risk/stress will be mitigated or
  • 7. lessened. i) Are any third parties assisting with this study that will have access to the data? ( FORMCHECKBOX ) No ( FORMCHECKBOX ) Yes (specify) ______________________________________ j) Will any aspect of the study take place outside of the United States? ( FORMCHECKBOX ) No ( FORMCHECKBOX ) Yes (specify where) _______________________________________ Note that IRB approval may be needed in the country where research is taking place. PLEASE PROVIDE HERE (OR AS AN ADDENDUM TO THIS APPLICATION) ANY ADDITIONAL INFORMATION OR EXPLANATION THAT YOU THINK MAY BE HELPFUL TO THE IRB REGARDING YOUR RESEARCH STUDY DESIGN OR IMPLEMENTATION. 5. Subject Groups: Will the subjects recruited to participate in this study include any that are in protected groups identified below as specified within the federal human subject guidelines? (The guidelines are defined at www.citiprogram.org) If any category from this list is checked “yes”, please explain in the “Comments” area below how the subjects will be protected from harm, risk, or stress as a study participant and
  • 8. how stress/risk will be mitigated or lessened. a. Children/minors under age 18? Yes ( FORMCHECKBOX ) No ( FORMCHECKBOX ) b. Prisoners? Yes ( FORMCHECKBOX ) No ( FORMCHECKBOX ) c. Pregnant women? Yes ( FORMCHECKBOX ) No ( FORMCHECKBOX ) d. Cognitively impaired or mentally disabled? Yes ( FORMCHECKBOX ) No ( FORMCHECKBOX ) e. Educationally or economically disadvantaged? Yes ( FORMCHECKBOX ) No ( FORMCHECKBOX ) Will the subjects be traumatized, comatose, or terminally ill
  • 9. patients? Yes ( FORMCHECKBOX ) No ( FORMCHECKBOX ) Will the subjects be elderly or aged persons? Yes ( FORMCHECKBOX ) No ( FORMCHECKBOX ) Will the subjects be minorities (including women)? Yes ( FORMCHECKBOX ) No ( FORMCHECKBOX ) Will information be withheld from subjects prior to, or during, participation? Yes ( FORMCHECKBOX ) No ( FORMCHECKBOX ) Will the subjects be college students? Yes ( FORMCHECKBOX ) No ( FORMCHECKBOX ) Will the subjects be deceived, misled, or coerced in any way? Yes ( FORMCHECKBOX ) No ( FORMCHECKBOX
  • 10. ) Will/might the subjects be students of the University of Phoenix? Yes ( FORMCHECKBOX ) No ( FORMCHECKBOX ) Will/might the subjects be faculty or staff of the University of Phoenix? Yes ( FORMCHECKBOX ) No ( FORMCHECKBOX ) Will information be requested that is, or may be, personal or sensitive? Yes ( FORMCHECKBOX ) No ( FORMCHECKBOX ) If the subjects are active duty military, will their supervisors have influence on their participation in this research or will participation be affected at all by the reporting relationship(s)? Yes ( FORMCHECKBOX ) No ( FORMCHECKBOX ) Will any aspect of this study involve subjects from countries outside of the U.S.? If yes, please specify in the comments section below. Yes ( FORMCHECKBOX )
  • 11. No ( FORMCHECKBOX ) Comments: 6. Subject Recruitment and Selection: Briefly explain and address the following: a) Which of the following will be used to find and recruit subjects? (check all that apply and include copies with this application) ( FORMCHECKBOX ) Flyers ( FORMCHECKBOX ) Email Announcement ( FORMCHECKBOX ) Events, Meetings, Conferences ( FORMCHECKBOX ) Area Canvassing ( FORMCHECKBOX ) Phone Solicitation ( FORMCHECKBOX ) Registry ( FORMCHECKBOX ) Newspaper/Radio/Television ( FORMCHECKBOX ) Referrals from Others ( FORMCHECKBOX ) Institutional “gatekeepers” ( FORMCHECKBOX ) Direct Mail ( FORMCHECKBOX ) Face to Face Interaction ( FORMCHECKBOX ) Internet/Websites ( FORMCHECKBOX
  • 12. ) Bulletin Board Post ( FORMCHECKBOX ) Social Media (e.g. LinkedIn, Facebook, etc.) (please specify ( FORMCHECKBOX ) Poster below; documented use permission is required) ( FORMCHECKBOX ) PhoenixConnect (please note if this is used, separate prior approval through the UOPX Committee on Research must be documented) ( FORMCHECKBOX ) Other (please specify)____________________________________________ EXPLAIN AND DESCRIBE HERE IF SOCIAL MEDIA WILL BE USED ____________________________________ b) What is the anticipated sample size? ( FORMCHECKBOX ) 10 or less ( FORMCHECKBOX ) 11-20 ( FORMCHECKBOX ) 21-50 ( FORMCHECKBOX ) 51-99 ( FORMCHECKBOX ) 100-199 ( FORMCHECKBOX ) 200 or more c) Will any external parties (such as editors, translators, interpreters, statisticians, etc.) provide assistance for recruitment purposes? (This does not pertain to persons who assist recruitment by “snowball sampling”.) ( FORMCHECKBOX ) No ( FORMCHECKBOX ) Yes (please identify and explain how they will assist) _____________________________
  • 13. d) Are any of the research subjects students, employees, or patients of the researcher? ( FORMCHECKBOX ) Yes ( FORMCHECKBOX ) No e) If any potential subjects under the age of 18 years are not selected to participate in this study, what activities will they be doing during the time the subjects are participating in the study so that they do not feel excluded or left out? If this scenario does not pertain to the study, please indicate “Not applicable” here. f) Please briefly describe the criteria that will be used to determine the inclusion or exclusion of subjects for this study. g) Will any compensation or remuneration be given to subjects for their participation in this study? ( FORMCHECKBOX ) No ( FORMCHECKBOX ) Yes (please identify amount and type, and the plan for dissemination. PLEASE PROVIDE HERE (OR AS AN ADDENDUM TO THIS APPLICATION) ANY ADDITIONAL INFORMATION OR EXPLANATION CONCERNING THE ABOVE QUESTIONS THAT YOU THINK MAY BE HELPFUL TO THE IRB REGARDING THE RECRUITMENT OF SUBJECTS FOR YOUR RESEARCH STUDY. 7. Informed Consent: Briefly explain and address the
  • 14. following questions. a) How will subjects be informed of the study’s purpose, procedures, intent, duration of the study and any potential risks or discomforts to them? Check all that apply: ( FORMCHECKBOX ) Informed Consent form ( FORMCHECKBOX ) Email ( FORMCHECKBOX ) Letter ( FORMCHECKBOX ) Meeting ( FORMCHECKBOX ) Phone Call ( FORMCHECKBOX ) Other _______ b) How will subjects be informed of withdrawal procedures? Check all that apply: ( FORMCHECKBOX ) Informed Consent form ( FORMCHECKBOX ) Email ( FORMCHECKBOX ) Letter ( FORMCHECKBOX ) Meeting ( FORMCHECKBOX ) Phone Call ( FORMCHECKBOX ) Other _______ c) How will the researcher contact information be provided to the subjects? Check all that apply: ( FORMCHECKBOX ) Informed Consent form ( FORMCHECKBOX ) Email ( FORMCHECKBOX ) Letter ( FORMCHECKBOX ) Meeting ( FORMCHECKBOX ) Phone Call ( FORMCHECKBOX ) Other _______
  • 15. d) How will subjects withdraw from the study as participants after data collection is completed? ( FORMCHECKBOX ) Email the researcher ( FORMCHECKBOX ) Phone call to researcher ( FORMCHECKBOX ) Submit withdrawal form ( FORMCHECKBOX ) Other (please specify) _____________________________________________________ ______ e) Please explain what subjects must do to withdraw from the study after data is collected and how subject data will be retrieved and handled to ensure security and confidentiality. f) If any subjects are under the age of 18 years, parental consent is required. What provision is made to answer any questions the parents have about this study or to address any individual concerns? (For example, will there be an informational meeting with the parents, etc.?) If this scenario does not apply to this study, please indicate “Not applicable” here. PLEASE PROVIDE HERE (OR AS AN ADDENDUM TO THIS APPLICATION) ANY ADDITIONAL INFORMATION OR EXPLANATION THAT YOU THINK MAY BE HELPFUL TO THE IRB REGARDING ANY OF THE ABOVE QUESTIONS OR ABOUT THE INFORMED CONSENT FOR YOUR RESEARCH STUDY. PLEASE READ AND CONFIRM THROUGH CHECK MARKING THE BOXES BELOW: FORMCHECKBOX
  • 16. I attest that no primary data collection from human subjects will occur without a prior signed Informed Consent form completed for each subject and that Informed Consent documentation will be retained separately from study data. FORMCHECKBOX I attest that a process for subject withdrawal will be implemented whereby subjects may withdraw without penalty before, during and after data collection has been completed and submitted and that the information they provided will be identified, secured, withdrawn and kept confidential. 8. Confidentiality and Privacy: Briefly explain and address how the identity and privacy of the individual subjects will be protected. Check any of the following that apply: a) How will subject identity and data be protected? ( FORMCHECKBOX ) Subject names will not be used or identified ( FORMCHECKBOX ) Pseudonyms or numbers will be used instead of subject names ( FORMCHECKBOX ) Data will be coded alphanumerically ( FORMCHECKBOX ) Other (please specify) ________________________________________________ b) Will any audio and/or video tape or other recording of
  • 17. data be done in this study? ( FORMCHECKBOX ) Yes ( FORMCHECKBOX ) No c) How long will the study data be kept after study completion? ( FORMCHECKBOX ) Three years (please note this is the minimum required retention time) ( FORMCHECKBOX ) More than three years d) Where will the data be stored: ( FORMCHECKBOX ) In an office or other location at the researcher’s residence ( FORMCHECKBOX ) At an office at the researcher’s place of employment ( FORMCHECKBOX ) At a third party facility (please specify) ________________________________ ( FORMCHECKBOX ) Other (please specify) ______________________________________________ e) How will data be destroyed at the appropriate time? ( FORMCHECKBOX ) Shredding ( FORMCHECKBOX ) Burning or incineration ( FORMCHECKBOX ) Smashing ( FORMCHECKBOX ) File Deletion ( FORMCHECKBOX
  • 18. ) Other (please specify) ______________________________________________ f) How will the results of this study be disseminated? ( FORMCHECKBOX ) Publication ( FORMCHECKBOX ) Presentation ( FORMCHECKBOX ) Other _____________________________ PLEASE PROVIDE HERE (OR AS AN ADDENDUM TO THIS APPLICATION) ANY ADDITIONAL INFORMATION OR EXPLANATION CONCERNING THE ABOVE THAT YOU THINK MAY BE HELPFUL TO THE IRB REGARDING CONFIDENTIALITY AND PRIVACY CONCERNS ASSOCIATED WITH YOUR RESEARCH STUDY. PLEASE READ AND CONFIRM THROUGH CHECK MARKING THE BOX BELOW: FORMCHECKBOX I attest that the data from this research will be kept in a secured location for at least three years following study completion, and then will be permanently destroyed. PAGE Current version 032012 6 Title ABC/123 Version X
  • 19. 1 1Experimental Designs WorksheetFill in the Blank Using the terms listed below, complete the following: 1. ___________ group receives treatment in an experimental design. 2. ___________ group does not receive treatment in an experimental design. 3. A ___________ design has many observations on a single case or a few subjects. 4. When separate groups of subjects receive different levels of the independent variable, this is referred to as _____________ design. 5. When all subjects receive all levels of the independent variable, this is referred to as ____________ design. 6. When the researcher measures a behavior that needs to be changed and then applies therapy and measures the behavior again, this is referred to as _____________ design. 7. When the researcher measures a behavior that needs to be changed, applies therapy and measures the behavior again, and then removes the treatment and measures the behavior again, this is referred to as ______________ design. 8. When the criterion outcome changes over time this is referred to as _______________ design. 9. When measuring several behaviors or several people with baseline periods of varying lengths and an independent variable occurs, this is referred to as a ______________ design.
  • 20. 10. When subjects are not randomly assigned and not all variables are under the control of the presenter, this is referred to as ______________ design. A. Multiple Baseline B. Small n C. AB D. Control E. Experimental F. ABA G. Between Subject H. Quasi-Experimental I. Changing Criterion J. Within Subject Matching Read the following scenarios and match each scenario with the correct type of experimental design. 1. _____ Two classes of children are studied regarding the effects of a new teaching method in science. One group received the new method of instruction, while the other group uses the standard, traditional method of instruction. Both classes are measures for achievement before and after the teaching methods. 2. _____ Divide your subjects in half. One group receives one treatment of the independent variable and the other group
  • 21. receives a different treatment of the independent variable. Subjects were all told they were going to see a video of a therapist's session after which they would rate the quality of the session. The groups differed in that the subjects in one group were told that prior evaluations indicated that the therapist was effective whereas subjects in the other group were told that the evaluations indicated the therapist was not effective. These different subjects were used for the two levels of the independent variable: subjects were in either the "effective therapist" or the "ineffective therapist" condition. 3. _____ All subjects perform at all levels of the independent variable. Subjects diagnosed as having attention deficit disorder were each tested on a concentration task after receiving medication. All subjects were tested four times, once after receiving one of the four doses. Each subject was tested under each of the four levels of the independent variable-dose of medication. 4. _____ A small group is measured for the amount of anxiety they experience in math class (baseline). They are taught a relaxation method and measured again to measure anxiety in math class. 5. _____ To study verbal commands in canines, during week 1 the baseline is recorded for how many times a dog chased a cat. During week 2, dog was verbally scolded (treatment) when the dog chased the cat, and the chasing behavior was recorded. During week 3, the chasing behavior was recorded without the verbal scolding (treatment). A. Between-Subjects Design B. AB Design
  • 22. C. Quasi-Experimental Design D. ABA Design E. Within-Subjects Design Copyright © XXXX by University of Phoenix. All rights reserved.