THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS ON.docxkenth16
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS ONLY TO BE COMPLETED AND SUBMITTED AS AN ASSIGNMENT FOR NSG6101.
INSTITUTIONAL REVIEW BOARD
FOR THE PROTECTION OF HUMAN SUBJECTS IN RESEARCH
This form is to be used for requesting IRB review for exempt, expedited and full board studies
Please note that handwritten and/or incomplete forms will be returned to you.
CHECKLIST FOR IRB APPLICATION SUBMISSION
(to be completed by PI before submission to IRB)
|_| Application Form with Signatures/ Confidentiality Agreements
|_| NIH Training Certificate(s)
|_| Protocol or Attached Research Proposal and/ or Contract/ Grant
|_| Solicitation Announcements/Recruitment Flyers
|_| Data Collection Instruments/Research Questions/Questionnaires/Surveys
|X| Informed Consent Documents
|X| Parental/Legal Guardian Permission Form (if applicable)
|X| Child Assent Form (if applicable)
|_| Approval from Study Sites (if applicable)
|_| Medical Screening Instrument (if applicable)
|_| Debriefing Plan (if applicable)
|_| Student as Principal Investigator Worksheet (if applicable)
Project Title
Effect of after school sports on BMI in overweight and obese children.
PART I - INVESTIGATOR and RESEARCH PERSONNEL
1) PRINCIPAL INVESTIGATOR
(Undergraduate students cannot serve as Principal Investigator, but may be listed as a Co-Investigator.)
Name:
Luis D. Valdes
|_| Dr. |X| Mr. |_| Ms. |_| Professor
Highest Degree Completed:
Bachelor
Investigator Status:
|_| Faculty |X| Graduate Student |_| Staff
E-mail Address:
[email protected]
College/Department:
School of Nursing
Campus Mailing Address:
709 Mall Blvd., Savannah, GA 31406
Daytime Phone:
972.505.1329
2) CO-INVESTIGATOR – 1 (if applicable)
Name:
|_| Dr. |_| Mr. |_| Ms. |_| Professor
Highest Degree Completed:
Investigator Status:
|_| Faculty |_| Graduate Student |_| Other
|_| Undergraduate |_| Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
3) CO-INVESTIGATOR – 2 (if applicable)
Name:
|_| Dr. |_| Mr. |_| Ms. |_| Professor
Highest Degree Completed:
Investigator Status:
|_| Faculty |_| Graduate Student |_| Other
|_| Undergraduate |_| Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
4) FACULTY SPONSOR (if applicable)
Name:
|_| Dr. |_| Mr. |_| Ms. |_| Professor
Highest Degree Completed:
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
5) STUDENT INVESTIGATORS/RESEARCH ASSISTANTS (if applicable)
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
PART II – FUNDING INFORMATION
1) Check all of the appropriate boxes for funding sources for this research. Include pending funding source(s).
|_| Extramural
|X| College
|_| Department
|_| Other:
P.I. of Grant or Contract:
Texas Health Research an.
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS .docxjuliennehar
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS ONLY TO BE COMPLETED AND SUBMITTED AS AN ASSIGNMENT FOR NSG6101.
INSTITUTIONAL REVIEW BOARD
FOR THE PROTECTION OF HUMAN SUBJECTS IN RESEARCH
This form is to be used for requesting IRB review for exempt, expedited and full board studies
Please note that handwritten and/or incomplete forms will be returned to you.
CHECKLIST FOR IRB APPLICATION SUBMISSION
(to be completed by PI before submission to IRB)
FORMCHECKBOX
Application Form with Signatures/ Confidentiality Agreements
FORMCHECKBOX
NIH Training Certificate(s)
FORMCHECKBOX
Protocol or Attached Research Proposal and/ or Contract/ Grant
FORMCHECKBOX
Solicitation Announcements/Recruitment Flyers
FORMCHECKBOX
Data Collection Instruments/Research Questions/Questionnaires/Surveys
FORMCHECKBOX
Informed Consent Documents
FORMCHECKBOX
Parental/Legal Guardian Permission Form (if applicable)
FORMCHECKBOX
Child Assent Form (if applicable)
FORMCHECKBOX
Approval from Study Sites (if applicable)
FORMCHECKBOX
Medical Screening Instrument (if applicable)
FORMCHECKBOX
Debriefing Plan (if applicable)
FORMCHECKBOX
Student as Principal Investigator Worksheet (if applicable)
Project Title
PART I - INVESTIGATOR and RESEARCH PERSONNEL
1) PRINCIPAL INVESTIGATOR
(Undergraduate students cannot serve as Principal Investigator, but may be listed as a Co-Investigator.)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
2) CO-INVESTIGATOR – 1 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
3) CO-INVESTIGATOR – 2 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
4) FACULTY SPONSOR (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
5) STUDENT INVESTIGATORS/RESEARCH ASSISTANTS (if applicable)
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail ...
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS blossomblackbourne
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS ONLY TO BE COMPLETED AND SUBMITTED AS AN ASSIGNMENT FOR NSG6101.
INSTITUTIONAL REVIEW BOARD
FOR THE PROTECTION OF HUMAN SUBJECTS IN RESEARCH
This form is to be used for requesting IRB review for exempt, expedited and full board studies
Please note that handwritten and/or incomplete forms will be returned to you.
CHECKLIST FOR IRB APPLICATION SUBMISSION
(to be completed by PI before submission to IRB)
FORMCHECKBOX
Application Form with Signatures/ Confidentiality Agreements
FORMCHECKBOX
NIH Training Certificate(s)
FORMCHECKBOX
Protocol or Attached Research Proposal and/ or Contract/ Grant
FORMCHECKBOX
Solicitation Announcements/Recruitment Flyers
FORMCHECKBOX
Data Collection Instruments/Research Questions/Questionnaires/Surveys
FORMCHECKBOX
Informed Consent Documents
FORMCHECKBOX
Parental/Legal Guardian Permission Form (if applicable)
FORMCHECKBOX
Child Assent Form (if applicable)
FORMCHECKBOX
Approval from Study Sites (if applicable)
FORMCHECKBOX
Medical Screening Instrument (if applicable)
FORMCHECKBOX
Debriefing Plan (if applicable)
FORMCHECKBOX
Student as Principal Investigator Worksheet (if applicable)
Project Title
PART I - INVESTIGATOR and RESEARCH PERSONNEL
1) PRINCIPAL INVESTIGATOR
(Undergraduate students cannot serve as Principal Investigator, but may be listed as a Co-Investigator.)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
2) CO-INVESTIGATOR – 1 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
3) CO-INVESTIGATOR – 2 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
4) FACULTY SPONSOR (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
5) STUDENT INVESTIGATORS/RESEARCH ASSISTANTS (if applicable)
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail ...
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS .docxchristalgrieg
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS ONLY TO BE COMPLETED AND SUBMITTED AS AN ASSIGNMENT FOR NSG6101.
INSTITUTIONAL REVIEW BOARD
FOR THE PROTECTION OF HUMAN SUBJECTS IN RESEARCH
This form is to be used for requesting IRB review for exempt, expedited and full board studies
Please note that handwritten and/or incomplete forms will be returned to you.
CHECKLIST FOR IRB APPLICATION SUBMISSION
(to be completed by PI before submission to IRB)
FORMCHECKBOX
Application Form with Signatures/ Confidentiality Agreements
FORMCHECKBOX
NIH Training Certificate(s)
FORMCHECKBOX
Protocol or Attached Research Proposal and/ or Contract/ Grant
FORMCHECKBOX
Solicitation Announcements/Recruitment Flyers
FORMCHECKBOX
Data Collection Instruments/Research Questions/Questionnaires/Surveys
FORMCHECKBOX
Informed Consent Documents
FORMCHECKBOX
Parental/Legal Guardian Permission Form (if applicable)
FORMCHECKBOX
Child Assent Form (if applicable)
FORMCHECKBOX
Approval from Study Sites (if applicable)
FORMCHECKBOX
Medical Screening Instrument (if applicable)
FORMCHECKBOX
Debriefing Plan (if applicable)
FORMCHECKBOX
Student as Principal Investigator Worksheet (if applicable)
Project Title
PART I - INVESTIGATOR and RESEARCH PERSONNEL
1) PRINCIPAL INVESTIGATOR
(Undergraduate students cannot serve as Principal Investigator, but may be listed as a Co-Investigator.)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
2) CO-INVESTIGATOR – 1 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
3) CO-INVESTIGATOR – 2 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
4) FACULTY SPONSOR (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
5) STUDENT INVESTIGATORS/RESEARCH ASSISTANTS (if applicable)
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail ...
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS GrazynaBroyles24
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS ONLY TO BE COMPLETED AND SUBMITTED AS AN ASSIGNMENT FOR NSG6101.
INSTITUTIONAL REVIEW BOARD
FOR THE PROTECTION OF HUMAN SUBJECTS IN RESEARCH
This form is to be used for requesting IRB review for exempt, expedited and full board studies
Please note that handwritten and/or incomplete forms will be returned to you.
CHECKLIST FOR IRB APPLICATION SUBMISSION
(to be completed by PI before submission to IRB)
FORMCHECKBOX
Application Form with Signatures/ Confidentiality Agreements
FORMCHECKBOX
NIH Training Certificate(s)
FORMCHECKBOX
Protocol or Attached Research Proposal and/ or Contract/ Grant
FORMCHECKBOX
Solicitation Announcements/Recruitment Flyers
FORMCHECKBOX
Data Collection Instruments/Research Questions/Questionnaires/Surveys
FORMCHECKBOX
Informed Consent Documents
FORMCHECKBOX
Parental/Legal Guardian Permission Form (if applicable)
FORMCHECKBOX
Child Assent Form (if applicable)
FORMCHECKBOX
Approval from Study Sites (if applicable)
FORMCHECKBOX
Medical Screening Instrument (if applicable)
FORMCHECKBOX
Debriefing Plan (if applicable)
FORMCHECKBOX
Student as Principal Investigator Worksheet (if applicable)
Project Title
PART I - INVESTIGATOR and RESEARCH PERSONNEL
1) PRINCIPAL INVESTIGATOR
(Undergraduate students cannot serve as Principal Investigator, but may be listed as a Co-Investigator.)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
2) CO-INVESTIGATOR – 1 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
3) CO-INVESTIGATOR – 2 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
4) FACULTY SPONSOR (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
5) STUDENT INVESTIGATORS/RESEARCH ASSISTANTS (if applicable)
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail ...
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS ON.docxkenth16
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS ONLY TO BE COMPLETED AND SUBMITTED AS AN ASSIGNMENT FOR NSG6101.
INSTITUTIONAL REVIEW BOARD
FOR THE PROTECTION OF HUMAN SUBJECTS IN RESEARCH
This form is to be used for requesting IRB review for exempt, expedited and full board studies
Please note that handwritten and/or incomplete forms will be returned to you.
CHECKLIST FOR IRB APPLICATION SUBMISSION
(to be completed by PI before submission to IRB)
|_| Application Form with Signatures/ Confidentiality Agreements
|_| NIH Training Certificate(s)
|_| Protocol or Attached Research Proposal and/ or Contract/ Grant
|_| Solicitation Announcements/Recruitment Flyers
|_| Data Collection Instruments/Research Questions/Questionnaires/Surveys
|X| Informed Consent Documents
|X| Parental/Legal Guardian Permission Form (if applicable)
|X| Child Assent Form (if applicable)
|_| Approval from Study Sites (if applicable)
|_| Medical Screening Instrument (if applicable)
|_| Debriefing Plan (if applicable)
|_| Student as Principal Investigator Worksheet (if applicable)
Project Title
Effect of after school sports on BMI in overweight and obese children.
PART I - INVESTIGATOR and RESEARCH PERSONNEL
1) PRINCIPAL INVESTIGATOR
(Undergraduate students cannot serve as Principal Investigator, but may be listed as a Co-Investigator.)
Name:
Luis D. Valdes
|_| Dr. |X| Mr. |_| Ms. |_| Professor
Highest Degree Completed:
Bachelor
Investigator Status:
|_| Faculty |X| Graduate Student |_| Staff
E-mail Address:
[email protected]
College/Department:
School of Nursing
Campus Mailing Address:
709 Mall Blvd., Savannah, GA 31406
Daytime Phone:
972.505.1329
2) CO-INVESTIGATOR – 1 (if applicable)
Name:
|_| Dr. |_| Mr. |_| Ms. |_| Professor
Highest Degree Completed:
Investigator Status:
|_| Faculty |_| Graduate Student |_| Other
|_| Undergraduate |_| Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
3) CO-INVESTIGATOR – 2 (if applicable)
Name:
|_| Dr. |_| Mr. |_| Ms. |_| Professor
Highest Degree Completed:
Investigator Status:
|_| Faculty |_| Graduate Student |_| Other
|_| Undergraduate |_| Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
4) FACULTY SPONSOR (if applicable)
Name:
|_| Dr. |_| Mr. |_| Ms. |_| Professor
Highest Degree Completed:
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
5) STUDENT INVESTIGATORS/RESEARCH ASSISTANTS (if applicable)
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
PART II – FUNDING INFORMATION
1) Check all of the appropriate boxes for funding sources for this research. Include pending funding source(s).
|_| Extramural
|X| College
|_| Department
|_| Other:
P.I. of Grant or Contract:
Texas Health Research an.
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS .docxjuliennehar
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS ONLY TO BE COMPLETED AND SUBMITTED AS AN ASSIGNMENT FOR NSG6101.
INSTITUTIONAL REVIEW BOARD
FOR THE PROTECTION OF HUMAN SUBJECTS IN RESEARCH
This form is to be used for requesting IRB review for exempt, expedited and full board studies
Please note that handwritten and/or incomplete forms will be returned to you.
CHECKLIST FOR IRB APPLICATION SUBMISSION
(to be completed by PI before submission to IRB)
FORMCHECKBOX
Application Form with Signatures/ Confidentiality Agreements
FORMCHECKBOX
NIH Training Certificate(s)
FORMCHECKBOX
Protocol or Attached Research Proposal and/ or Contract/ Grant
FORMCHECKBOX
Solicitation Announcements/Recruitment Flyers
FORMCHECKBOX
Data Collection Instruments/Research Questions/Questionnaires/Surveys
FORMCHECKBOX
Informed Consent Documents
FORMCHECKBOX
Parental/Legal Guardian Permission Form (if applicable)
FORMCHECKBOX
Child Assent Form (if applicable)
FORMCHECKBOX
Approval from Study Sites (if applicable)
FORMCHECKBOX
Medical Screening Instrument (if applicable)
FORMCHECKBOX
Debriefing Plan (if applicable)
FORMCHECKBOX
Student as Principal Investigator Worksheet (if applicable)
Project Title
PART I - INVESTIGATOR and RESEARCH PERSONNEL
1) PRINCIPAL INVESTIGATOR
(Undergraduate students cannot serve as Principal Investigator, but may be listed as a Co-Investigator.)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
2) CO-INVESTIGATOR – 1 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
3) CO-INVESTIGATOR – 2 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
4) FACULTY SPONSOR (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
5) STUDENT INVESTIGATORS/RESEARCH ASSISTANTS (if applicable)
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail ...
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS blossomblackbourne
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS ONLY TO BE COMPLETED AND SUBMITTED AS AN ASSIGNMENT FOR NSG6101.
INSTITUTIONAL REVIEW BOARD
FOR THE PROTECTION OF HUMAN SUBJECTS IN RESEARCH
This form is to be used for requesting IRB review for exempt, expedited and full board studies
Please note that handwritten and/or incomplete forms will be returned to you.
CHECKLIST FOR IRB APPLICATION SUBMISSION
(to be completed by PI before submission to IRB)
FORMCHECKBOX
Application Form with Signatures/ Confidentiality Agreements
FORMCHECKBOX
NIH Training Certificate(s)
FORMCHECKBOX
Protocol or Attached Research Proposal and/ or Contract/ Grant
FORMCHECKBOX
Solicitation Announcements/Recruitment Flyers
FORMCHECKBOX
Data Collection Instruments/Research Questions/Questionnaires/Surveys
FORMCHECKBOX
Informed Consent Documents
FORMCHECKBOX
Parental/Legal Guardian Permission Form (if applicable)
FORMCHECKBOX
Child Assent Form (if applicable)
FORMCHECKBOX
Approval from Study Sites (if applicable)
FORMCHECKBOX
Medical Screening Instrument (if applicable)
FORMCHECKBOX
Debriefing Plan (if applicable)
FORMCHECKBOX
Student as Principal Investigator Worksheet (if applicable)
Project Title
PART I - INVESTIGATOR and RESEARCH PERSONNEL
1) PRINCIPAL INVESTIGATOR
(Undergraduate students cannot serve as Principal Investigator, but may be listed as a Co-Investigator.)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
2) CO-INVESTIGATOR – 1 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
3) CO-INVESTIGATOR – 2 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
4) FACULTY SPONSOR (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
5) STUDENT INVESTIGATORS/RESEARCH ASSISTANTS (if applicable)
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail ...
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS .docxchristalgrieg
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS ONLY TO BE COMPLETED AND SUBMITTED AS AN ASSIGNMENT FOR NSG6101.
INSTITUTIONAL REVIEW BOARD
FOR THE PROTECTION OF HUMAN SUBJECTS IN RESEARCH
This form is to be used for requesting IRB review for exempt, expedited and full board studies
Please note that handwritten and/or incomplete forms will be returned to you.
CHECKLIST FOR IRB APPLICATION SUBMISSION
(to be completed by PI before submission to IRB)
FORMCHECKBOX
Application Form with Signatures/ Confidentiality Agreements
FORMCHECKBOX
NIH Training Certificate(s)
FORMCHECKBOX
Protocol or Attached Research Proposal and/ or Contract/ Grant
FORMCHECKBOX
Solicitation Announcements/Recruitment Flyers
FORMCHECKBOX
Data Collection Instruments/Research Questions/Questionnaires/Surveys
FORMCHECKBOX
Informed Consent Documents
FORMCHECKBOX
Parental/Legal Guardian Permission Form (if applicable)
FORMCHECKBOX
Child Assent Form (if applicable)
FORMCHECKBOX
Approval from Study Sites (if applicable)
FORMCHECKBOX
Medical Screening Instrument (if applicable)
FORMCHECKBOX
Debriefing Plan (if applicable)
FORMCHECKBOX
Student as Principal Investigator Worksheet (if applicable)
Project Title
PART I - INVESTIGATOR and RESEARCH PERSONNEL
1) PRINCIPAL INVESTIGATOR
(Undergraduate students cannot serve as Principal Investigator, but may be listed as a Co-Investigator.)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
2) CO-INVESTIGATOR – 1 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
3) CO-INVESTIGATOR – 2 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
4) FACULTY SPONSOR (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
5) STUDENT INVESTIGATORS/RESEARCH ASSISTANTS (if applicable)
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail ...
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS GrazynaBroyles24
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS ONLY TO BE COMPLETED AND SUBMITTED AS AN ASSIGNMENT FOR NSG6101.
INSTITUTIONAL REVIEW BOARD
FOR THE PROTECTION OF HUMAN SUBJECTS IN RESEARCH
This form is to be used for requesting IRB review for exempt, expedited and full board studies
Please note that handwritten and/or incomplete forms will be returned to you.
CHECKLIST FOR IRB APPLICATION SUBMISSION
(to be completed by PI before submission to IRB)
FORMCHECKBOX
Application Form with Signatures/ Confidentiality Agreements
FORMCHECKBOX
NIH Training Certificate(s)
FORMCHECKBOX
Protocol or Attached Research Proposal and/ or Contract/ Grant
FORMCHECKBOX
Solicitation Announcements/Recruitment Flyers
FORMCHECKBOX
Data Collection Instruments/Research Questions/Questionnaires/Surveys
FORMCHECKBOX
Informed Consent Documents
FORMCHECKBOX
Parental/Legal Guardian Permission Form (if applicable)
FORMCHECKBOX
Child Assent Form (if applicable)
FORMCHECKBOX
Approval from Study Sites (if applicable)
FORMCHECKBOX
Medical Screening Instrument (if applicable)
FORMCHECKBOX
Debriefing Plan (if applicable)
FORMCHECKBOX
Student as Principal Investigator Worksheet (if applicable)
Project Title
PART I - INVESTIGATOR and RESEARCH PERSONNEL
1) PRINCIPAL INVESTIGATOR
(Undergraduate students cannot serve as Principal Investigator, but may be listed as a Co-Investigator.)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
2) CO-INVESTIGATOR – 1 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
3) CO-INVESTIGATOR – 2 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
4) FACULTY SPONSOR (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
5) STUDENT INVESTIGATORS/RESEARCH ASSISTANTS (if applicable)
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail ...
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS .docxkenth16
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS ONLY TO BE COMPLETED AND SUBMITTED AS AN ASSIGNMENT FOR NSG6101.
INSTITUTIONAL REVIEW BOARD
FOR THE PROTECTION OF HUMAN SUBJECTS IN RESEARCH
This form is to be used for requesting IRB review for exempt, expedited and full board studies
Please note that handwritten and/or incomplete forms will be returned to you.
CHECKLIST FOR IRB APPLICATION SUBMISSION
(to be completed by PI before submission to IRB)
FORMCHECKBOX
Application Form with Signatures/ Confidentiality Agreements
FORMCHECKBOX
NIH Training Certificate(s)
FORMCHECKBOX
Protocol or Attached Research Proposal and/ or Contract/ Grant
FORMCHECKBOX
Solicitation Announcements/Recruitment Flyers
FORMCHECKBOX
Data Collection Instruments/Research Questions/Questionnaires/Surveys
FORMCHECKBOX
Informed Consent Documents
FORMCHECKBOX
Parental/Legal Guardian Permission Form (if applicable)
FORMCHECKBOX
Child Assent Form (if applicable)
FORMCHECKBOX
Approval from Study Sites (if applicable)
FORMCHECKBOX
Medical Screening Instrument (if applicable)
FORMCHECKBOX
Debriefing Plan (if applicable)
FORMCHECKBOX
Student as Principal Investigator Worksheet (if applicable)
Project Title
PART I - INVESTIGATOR and RESEARCH PERSONNEL
1) PRINCIPAL INVESTIGATOR
(Undergraduate students cannot serve as Principal Investigator, but may be listed as a Co-Investigator.)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
2) CO-INVESTIGATOR – 1 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
3) CO-INVESTIGATOR – 2 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
4) FACULTY SPONSOR (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
5) STUDENT INVESTIGATORS/RESEARCH ASSISTANTS (if applicable)
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail.
College of Arts and Social SciencesEthical Approval Form.docxmccormicknadine86
College of Arts and Social Sciences
Ethical Approval Form
This form should be completed and submitted to the appropriate supervisor or School Ethics Officer for consideration by the College Research Ethics and Governance Committee.
Important Note: If your research involves NHS patients, tissue or data, or NHS staff, please contact [email protected] for further guidance on ethical approval procedures.
BEFORE COMPLETING THIS FORM APPLICANTS SHOULD REFER TO:
1. The College Checklist of Good Research Practice:
http://www.abdn.ac.uk/cass/documents/CASS_Ethics_Checklist_June_2015.pdf
2. The College Research Ethics web pages can be found at: www.abdn.ac.uk/cass/research/research-ethics-and-governance-325-php
3. Information on data management, collecting personal data and data protection act requirements can be found at: http://www.abdn.ac.uk/staffnet/documents/policy-zone-governance-and-compliance/data_protection_policy_April_2015.pdf
4. Information on University Expectations of researchers can be found in the University’s Framework for Research Governance at: http://www.abdn.ac.uk/staffnet/research/research-governance-304.php
WHEN COMPLETING THE FORM APPLICANTS ARE REQUIRED TO:
1. Consider each question carefully and provide details of potential ethical issues which might arise, allowing the reviewer to make an informed decision on whether they have been addressed appropriately. Applicants are expected to provide additional information beyond the initial ‘yes’/’no’ answer to the questions provided.
Failure to provide enough information to allow the reviewer to provide informed approval of ethical issues within the research might result in the need to restart the review process.
2. For all applications, researchers must provide a brief explanation of the potential ethical issues which might arise when carrying out the research/course (e.g. justification of the need to use certain research methodologies which might raise potential ethical concerns) and how they are to be addressed. This should be provided in a separate Word document appended to the application. For clearly defined research projects/courses, the project proposal or course outline document should also be attached. Any other documents relevant to the research (e.g. consent forms) should also be attached to the application.
Code and Title of Course/Project:
Name of Principal Investigator or CourseCo-ordinator:
Project/Course Start Date:
Additional Research staff (if applicable):
Add
Application Date:
Signature of Course Co-Ordinator:
Recruitment procedures
Yes
No
N/A
1
Does your research activity involve persons less than 18 years of age? If yes, please provide further information.
2
Does your research activity involve people with learning or communication difficulties? (Note: all research involving participants for whom provision is made under the Mental Capacity Act 2005 must be ethically reviewed by NHS NRES). If yes, please provide further infor ...
Ask an NIH Program Officer: Tips and Tools for New & Early-Stage ResearchersNorbert Tavares, Ph.D.
Tips and tools for new and early-career researchers to navigate the NIH funding system. Presented at the Experimental Biology Conference in Orlando FL, 4/8/19. Opening panel presentation by Norbert Tavares, Ph.D., AAAS Science Policy Fellow and Program Manager at the National Cancer Institute at NIH.
APPLICATION FOR THE USE OF HUMAN RESEARCH PARTICIPANTSIRB AP.docxfestockton
APPLICATION FOR THE USE OF HUMAN RESEARCH PARTICIPANTS
IRB APPLICATION #: (To be assigned by the IRB)
______________________________________________________________________________
I. APPLICATION INSTRUCTIONS
1. Complete each section of this document by using your tab key to move your cursor to each gray form field and providing the requested information.
2. If you have questions, hover over the blue (?), or refer to the IRB Application Instructions for additional clarification.
3. Review the IRB Application Checklist.
4. Email the completed application, with the following supporting documents (as separate word documents) to [email protected]:
a. Consent Forms, Permission Letters, Recruitment Materials
b. Surveys, Questionnaires, Interview Questions, Focus Group Questions
5. If you plan to use a specific Liberty University department or population for your study, you will need to obtain permission from the appropriate department chair/dean/coach/etc. Submit documentation of permission (email or letter) to the IRB along with this application and check the indicated box below verifying that you have done so.
6. Submit one signed copy of the signature page (available on the IRB website or electronically by request) to any of the following:
a. Email: As a scanned document to [email protected]
b. Fax: 434-522-0506
c. Mail: IRB 1971 University Blvd. Lynchburg, VA 24515
d. In Person: Green Hall, Suite 2845
7. Once received, the IRB processes applications on a first-come, first-served basis.
8. Preliminary review may take up to 3 weeks.
9. Most applications will require 3 sets of revisions.
10. The entire process may take between 1 and 2 months.
11. We cannot accept applications in formats other than Microsoft Word. Please do not send us One Drive files, Pdfs, Google Docs, or Html applications. Exception: The IRB’s signature page, proprietary instruments (i.e., survey creator has copyright), and documentation of permission may be submitted as pdfs.
Note: Applications and supporting documents with the following problems will be returned immediately for revisions:
1. Grammar, spelling, or punctuation errors
2. Lack of professionalism
3. Lack of consistency or clarity
4. Incomplete applications
**Failure to minimize these errors will cause delays in your processing time**
______________________________________________________________________________
II. BASIC PROTOCOL INFORMATION
1. STUDY/THESIS/DISSERTATION TITLE (?)
Title:
2. PRINCIPAL INVESTIGATOR & PROTOCOL INFORMATION (?)
Principal Investigator(person conducting the research):
Professional Title (Student, Professor, etc.):
School/Department (School of Education, LUCOM, etc.):
Phone:
LU Email:
Check all that apply:
|_| Faculty
|_| Online Graduate Student
|_| Staff
|_| Residential Undergraduate Student
|_| Residential Graduate Student
|_| Online Undergraduate Student
This research is for:
|_| Class Project
|_| Master’s Thesis
|_| Scholarly Project (DNP Program)
|_| Doctoral Disserta ...
This document applies to all students registered as a student at Anglia Ruskin University in the Ashcroft International Business School (AIBS), and all their Partner Institutions, regarding the ethical approval of Undergraduate, Taught Postgraduate Masters Dissertations, Research–based Management Research Reports, and Work-based projects. For those undertaking any research/project work outside the UK you are required to ensure that your research/study/project complies with UK legal and ethical requirements.
Running head 1-3 FINAL PROJECT MILESTONE ONE samirapdcosden
Running head: 1-3 FINAL PROJECT: MILESTONE ONE 1
PHE 330 FINAL PROJECT: MILESTONE ONE 5
1-3 Final Project: Milestone One
Artis Johnson
Public Health Education & Communication
Tami Ford
Southern New Hampshire University
September 4, 2022
I. Health Problem.
I have chosen to complete my final project discussing Human Immunodeficiency Virus (HIV). There are quite a few people that I know that are near and dear to my heart living with this virus. There are many misconceptions about HIV that the public has simply due to unawareness. With most common public health issues there are many questions that need to be answered to solve the myths. Mental health and substance use disorders can also make it difficult for people to take their medications as prescribed. When HIV is not treated or maintained, it can lead to the fatal diseases Acquired Immune Deficiency Syndrome (AIDS). Of note, you cannot have AIDS without being infected with HIV. According to the Center for Disease Control, HIV can affect anyone regardless of sexual orientation, race, ethnicity, gender, or age (CDC, 2022). However, certain groups are at a higher risk for HIV and weigh special considerations due to the specific risk factors. Gay and Bisexual men, pregnant women, infants, children, Transgender people, people who exchange sex for money, people who inject drugs, etc. These are all considerations of the causes for higher risk for being affected by HIV. However, with the modern medicines and treatments for HIV, many have been known to live long and healthy lives.
II. Organization.
The organization that I have chosen is the World Health Organization (WHO). WHO was founded in 1948 and is the United Nations Agency that connects nations, partners, and people to promote health, keep the world safe and serve the vulnerable – so everyone, everywhere can attain the highest level of health (WHO, 2022). My role in this organization will be a Public Health Physician. WHO works closely with United Nations Children’s Fund (UNICEF) on Elimination of Mother-to Child Transmission (EMTCT) of HIV and pediatric AIDS and works with United Nations Population Fund (UNFPA) on the integration of HIV and Sexual and Reproductive Health and Rights (SRHR). WHO considers the epidemiological, technological, and contextual trends of previous years, promotes learning with each disease area, and generates opportunities to leverage innovations and knowledge for efficient responses to HIV and sexually transmitted infections (STI). Thanks to awareness and past research, WHO is able to provide a in depth analysis of the past and current trends of HIV and other STI through multiple platforms.
References
Centers for Disease Control and Prevention. (2022, August 5).
HIV. Centers for Disease Control and Prevention. Retrieved September 4, 2022, from https://ww ...
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S INFORMED CONSENT LETTER A.docxchristalgrieg
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S INFORMED CONSENT LETTER AND IS ONLY TO BE COMPLETED AND SUBMITTED AS AN ASSIGNMENT FOR NSG6101.
For Official Use Only
Date received:
Date reviewed:
End date:
File #:
SELF CONSENT
I have been invited to take part in a research study titled:
This study is being conducted by, who can be contacted at:
I understand that my participation is voluntary and that I can refuse to participate or stop taking part any time without giving any reason and without facing any penalty. Additionally, I have the right to request the return, removal, or destruction of any information relating to me or my participation.
PURPOSE OF STUDY
I understand that the purpose of the study is to:
PROCEDURES
I understand that if I volunteer to take part in this study, I will be asked to:
BENEFITS
I understand that the benefits I may gain from participation include:
RISKS
I understand that the risks, discomforts, or stresses I may face during participation include:
CONFIDENTIALITY
I understand that the only people who will know that I am a research subject are members of the research team. No individually-identifiable information about me, or provided by me during the study will be shared with others except when necessary to protect the rights and welfare of myself and others (for example, if I am injured and need emergency care, if the provided information concerns suicide, homicide, or child abuse, or if revealing the information is required by law).
FURTHER QUESTIONS
I understand that any further questions that I have, now or during the course of the study can be directed to the researcher ( ).
Additionally, I understand that questions or problems regarding my rights as a research participant can be addressed to Dr. Jessica Hillyer, Institutional Review Board Director of Compliance and Training, South University, 7700 W. Parmer Ln., Austin, TX 78729;
jhillyer[email protected]; 512-516-8779.
My signature below indicates that the researchers have satisfactorily answered all of my current questions about this study and that I understand the purpose, procedures, benefits, and risks described above. I have also been offered a copy of this form to keep for my own records.
Participant Printed Name
Signature of Participant Date (mm/dd/yyyy)
Signature of Principal Investigator Date (mm/dd/yyyy)
Page 1 of 2
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS ONLY TO BE COMPLETED AND SUBMITTED AS AN ASSIGNMENT FOR NSG6101.
INSTITUTIONAL REVIEW BOARD
FOR THE PROTECTION OF HUMAN SUBJECTS IN RESEARCH
This form is to be used for requesting IRB review for exempt, expedited and full board studies
Please note that handwritten and/or incomplete forms will be returned to you.
CHECKLIST FOR IRB APPLICATION SUBMISSION
(to be completed by PI before submission to IRB)
FORMCHECKBOX
Application Form with Signatures/ Confidentiality Agreements
FORMCHECK ...
Delivering Micro-Credentials in Technical and Vocational Education and TrainingAG2 Design
Explore how micro-credentials are transforming Technical and Vocational Education and Training (TVET) with this comprehensive slide deck. Discover what micro-credentials are, their importance in TVET, the advantages they offer, and the insights from industry experts. Additionally, learn about the top software applications available for creating and managing micro-credentials. This presentation also includes valuable resources and a discussion on the future of these specialised certifications.
For more detailed information on delivering micro-credentials in TVET, visit this https://tvettrainer.com/delivering-micro-credentials-in-tvet/
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS .docxkenth16
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS ONLY TO BE COMPLETED AND SUBMITTED AS AN ASSIGNMENT FOR NSG6101.
INSTITUTIONAL REVIEW BOARD
FOR THE PROTECTION OF HUMAN SUBJECTS IN RESEARCH
This form is to be used for requesting IRB review for exempt, expedited and full board studies
Please note that handwritten and/or incomplete forms will be returned to you.
CHECKLIST FOR IRB APPLICATION SUBMISSION
(to be completed by PI before submission to IRB)
FORMCHECKBOX
Application Form with Signatures/ Confidentiality Agreements
FORMCHECKBOX
NIH Training Certificate(s)
FORMCHECKBOX
Protocol or Attached Research Proposal and/ or Contract/ Grant
FORMCHECKBOX
Solicitation Announcements/Recruitment Flyers
FORMCHECKBOX
Data Collection Instruments/Research Questions/Questionnaires/Surveys
FORMCHECKBOX
Informed Consent Documents
FORMCHECKBOX
Parental/Legal Guardian Permission Form (if applicable)
FORMCHECKBOX
Child Assent Form (if applicable)
FORMCHECKBOX
Approval from Study Sites (if applicable)
FORMCHECKBOX
Medical Screening Instrument (if applicable)
FORMCHECKBOX
Debriefing Plan (if applicable)
FORMCHECKBOX
Student as Principal Investigator Worksheet (if applicable)
Project Title
PART I - INVESTIGATOR and RESEARCH PERSONNEL
1) PRINCIPAL INVESTIGATOR
(Undergraduate students cannot serve as Principal Investigator, but may be listed as a Co-Investigator.)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
2) CO-INVESTIGATOR – 1 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
3) CO-INVESTIGATOR – 2 (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
Investigator Status:
FORMCHECKBOX
Faculty FORMCHECKBOX
Graduate Student FORMCHECKBOX
Other
FORMCHECKBOX
Undergraduate FORMCHECKBOX
Staff
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
4) FACULTY SPONSOR (if applicable)
Name:
FORMCHECKBOX
Dr. FORMCHECKBOX
Mr. FORMCHECKBOX
Ms. FORMCHECKBOX
Professor
Highest Degree Completed:
E-mail Address:
College/Department:
Campus Mailing Address:
Daytime Phone:
5) STUDENT INVESTIGATORS/RESEARCH ASSISTANTS (if applicable)
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail:
Phone:
Name:
E-mail.
College of Arts and Social SciencesEthical Approval Form.docxmccormicknadine86
College of Arts and Social Sciences
Ethical Approval Form
This form should be completed and submitted to the appropriate supervisor or School Ethics Officer for consideration by the College Research Ethics and Governance Committee.
Important Note: If your research involves NHS patients, tissue or data, or NHS staff, please contact [email protected] for further guidance on ethical approval procedures.
BEFORE COMPLETING THIS FORM APPLICANTS SHOULD REFER TO:
1. The College Checklist of Good Research Practice:
http://www.abdn.ac.uk/cass/documents/CASS_Ethics_Checklist_June_2015.pdf
2. The College Research Ethics web pages can be found at: www.abdn.ac.uk/cass/research/research-ethics-and-governance-325-php
3. Information on data management, collecting personal data and data protection act requirements can be found at: http://www.abdn.ac.uk/staffnet/documents/policy-zone-governance-and-compliance/data_protection_policy_April_2015.pdf
4. Information on University Expectations of researchers can be found in the University’s Framework for Research Governance at: http://www.abdn.ac.uk/staffnet/research/research-governance-304.php
WHEN COMPLETING THE FORM APPLICANTS ARE REQUIRED TO:
1. Consider each question carefully and provide details of potential ethical issues which might arise, allowing the reviewer to make an informed decision on whether they have been addressed appropriately. Applicants are expected to provide additional information beyond the initial ‘yes’/’no’ answer to the questions provided.
Failure to provide enough information to allow the reviewer to provide informed approval of ethical issues within the research might result in the need to restart the review process.
2. For all applications, researchers must provide a brief explanation of the potential ethical issues which might arise when carrying out the research/course (e.g. justification of the need to use certain research methodologies which might raise potential ethical concerns) and how they are to be addressed. This should be provided in a separate Word document appended to the application. For clearly defined research projects/courses, the project proposal or course outline document should also be attached. Any other documents relevant to the research (e.g. consent forms) should also be attached to the application.
Code and Title of Course/Project:
Name of Principal Investigator or CourseCo-ordinator:
Project/Course Start Date:
Additional Research staff (if applicable):
Add
Application Date:
Signature of Course Co-Ordinator:
Recruitment procedures
Yes
No
N/A
1
Does your research activity involve persons less than 18 years of age? If yes, please provide further information.
2
Does your research activity involve people with learning or communication difficulties? (Note: all research involving participants for whom provision is made under the Mental Capacity Act 2005 must be ethically reviewed by NHS NRES). If yes, please provide further infor ...
Ask an NIH Program Officer: Tips and Tools for New & Early-Stage ResearchersNorbert Tavares, Ph.D.
Tips and tools for new and early-career researchers to navigate the NIH funding system. Presented at the Experimental Biology Conference in Orlando FL, 4/8/19. Opening panel presentation by Norbert Tavares, Ph.D., AAAS Science Policy Fellow and Program Manager at the National Cancer Institute at NIH.
APPLICATION FOR THE USE OF HUMAN RESEARCH PARTICIPANTSIRB AP.docxfestockton
APPLICATION FOR THE USE OF HUMAN RESEARCH PARTICIPANTS
IRB APPLICATION #: (To be assigned by the IRB)
______________________________________________________________________________
I. APPLICATION INSTRUCTIONS
1. Complete each section of this document by using your tab key to move your cursor to each gray form field and providing the requested information.
2. If you have questions, hover over the blue (?), or refer to the IRB Application Instructions for additional clarification.
3. Review the IRB Application Checklist.
4. Email the completed application, with the following supporting documents (as separate word documents) to [email protected]:
a. Consent Forms, Permission Letters, Recruitment Materials
b. Surveys, Questionnaires, Interview Questions, Focus Group Questions
5. If you plan to use a specific Liberty University department or population for your study, you will need to obtain permission from the appropriate department chair/dean/coach/etc. Submit documentation of permission (email or letter) to the IRB along with this application and check the indicated box below verifying that you have done so.
6. Submit one signed copy of the signature page (available on the IRB website or electronically by request) to any of the following:
a. Email: As a scanned document to [email protected]
b. Fax: 434-522-0506
c. Mail: IRB 1971 University Blvd. Lynchburg, VA 24515
d. In Person: Green Hall, Suite 2845
7. Once received, the IRB processes applications on a first-come, first-served basis.
8. Preliminary review may take up to 3 weeks.
9. Most applications will require 3 sets of revisions.
10. The entire process may take between 1 and 2 months.
11. We cannot accept applications in formats other than Microsoft Word. Please do not send us One Drive files, Pdfs, Google Docs, or Html applications. Exception: The IRB’s signature page, proprietary instruments (i.e., survey creator has copyright), and documentation of permission may be submitted as pdfs.
Note: Applications and supporting documents with the following problems will be returned immediately for revisions:
1. Grammar, spelling, or punctuation errors
2. Lack of professionalism
3. Lack of consistency or clarity
4. Incomplete applications
**Failure to minimize these errors will cause delays in your processing time**
______________________________________________________________________________
II. BASIC PROTOCOL INFORMATION
1. STUDY/THESIS/DISSERTATION TITLE (?)
Title:
2. PRINCIPAL INVESTIGATOR & PROTOCOL INFORMATION (?)
Principal Investigator(person conducting the research):
Professional Title (Student, Professor, etc.):
School/Department (School of Education, LUCOM, etc.):
Phone:
LU Email:
Check all that apply:
|_| Faculty
|_| Online Graduate Student
|_| Staff
|_| Residential Undergraduate Student
|_| Residential Graduate Student
|_| Online Undergraduate Student
This research is for:
|_| Class Project
|_| Master’s Thesis
|_| Scholarly Project (DNP Program)
|_| Doctoral Disserta ...
This document applies to all students registered as a student at Anglia Ruskin University in the Ashcroft International Business School (AIBS), and all their Partner Institutions, regarding the ethical approval of Undergraduate, Taught Postgraduate Masters Dissertations, Research–based Management Research Reports, and Work-based projects. For those undertaking any research/project work outside the UK you are required to ensure that your research/study/project complies with UK legal and ethical requirements.
Running head 1-3 FINAL PROJECT MILESTONE ONE samirapdcosden
Running head: 1-3 FINAL PROJECT: MILESTONE ONE 1
PHE 330 FINAL PROJECT: MILESTONE ONE 5
1-3 Final Project: Milestone One
Artis Johnson
Public Health Education & Communication
Tami Ford
Southern New Hampshire University
September 4, 2022
I. Health Problem.
I have chosen to complete my final project discussing Human Immunodeficiency Virus (HIV). There are quite a few people that I know that are near and dear to my heart living with this virus. There are many misconceptions about HIV that the public has simply due to unawareness. With most common public health issues there are many questions that need to be answered to solve the myths. Mental health and substance use disorders can also make it difficult for people to take their medications as prescribed. When HIV is not treated or maintained, it can lead to the fatal diseases Acquired Immune Deficiency Syndrome (AIDS). Of note, you cannot have AIDS without being infected with HIV. According to the Center for Disease Control, HIV can affect anyone regardless of sexual orientation, race, ethnicity, gender, or age (CDC, 2022). However, certain groups are at a higher risk for HIV and weigh special considerations due to the specific risk factors. Gay and Bisexual men, pregnant women, infants, children, Transgender people, people who exchange sex for money, people who inject drugs, etc. These are all considerations of the causes for higher risk for being affected by HIV. However, with the modern medicines and treatments for HIV, many have been known to live long and healthy lives.
II. Organization.
The organization that I have chosen is the World Health Organization (WHO). WHO was founded in 1948 and is the United Nations Agency that connects nations, partners, and people to promote health, keep the world safe and serve the vulnerable – so everyone, everywhere can attain the highest level of health (WHO, 2022). My role in this organization will be a Public Health Physician. WHO works closely with United Nations Children’s Fund (UNICEF) on Elimination of Mother-to Child Transmission (EMTCT) of HIV and pediatric AIDS and works with United Nations Population Fund (UNFPA) on the integration of HIV and Sexual and Reproductive Health and Rights (SRHR). WHO considers the epidemiological, technological, and contextual trends of previous years, promotes learning with each disease area, and generates opportunities to leverage innovations and knowledge for efficient responses to HIV and sexually transmitted infections (STI). Thanks to awareness and past research, WHO is able to provide a in depth analysis of the past and current trends of HIV and other STI through multiple platforms.
References
Centers for Disease Control and Prevention. (2022, August 5).
HIV. Centers for Disease Control and Prevention. Retrieved September 4, 2022, from https://ww ...
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S INFORMED CONSENT LETTER A.docxchristalgrieg
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S INFORMED CONSENT LETTER AND IS ONLY TO BE COMPLETED AND SUBMITTED AS AN ASSIGNMENT FOR NSG6101.
For Official Use Only
Date received:
Date reviewed:
End date:
File #:
SELF CONSENT
I have been invited to take part in a research study titled:
This study is being conducted by, who can be contacted at:
I understand that my participation is voluntary and that I can refuse to participate or stop taking part any time without giving any reason and without facing any penalty. Additionally, I have the right to request the return, removal, or destruction of any information relating to me or my participation.
PURPOSE OF STUDY
I understand that the purpose of the study is to:
PROCEDURES
I understand that if I volunteer to take part in this study, I will be asked to:
BENEFITS
I understand that the benefits I may gain from participation include:
RISKS
I understand that the risks, discomforts, or stresses I may face during participation include:
CONFIDENTIALITY
I understand that the only people who will know that I am a research subject are members of the research team. No individually-identifiable information about me, or provided by me during the study will be shared with others except when necessary to protect the rights and welfare of myself and others (for example, if I am injured and need emergency care, if the provided information concerns suicide, homicide, or child abuse, or if revealing the information is required by law).
FURTHER QUESTIONS
I understand that any further questions that I have, now or during the course of the study can be directed to the researcher ( ).
Additionally, I understand that questions or problems regarding my rights as a research participant can be addressed to Dr. Jessica Hillyer, Institutional Review Board Director of Compliance and Training, South University, 7700 W. Parmer Ln., Austin, TX 78729;
jhillyer[email protected]; 512-516-8779.
My signature below indicates that the researchers have satisfactorily answered all of my current questions about this study and that I understand the purpose, procedures, benefits, and risks described above. I have also been offered a copy of this form to keep for my own records.
Participant Printed Name
Signature of Participant Date (mm/dd/yyyy)
Signature of Principal Investigator Date (mm/dd/yyyy)
Page 1 of 2
THIS IS AN EXAMPLE OF SOUTH UNIVERSITY’S IRB APPLICATION AND IS ONLY TO BE COMPLETED AND SUBMITTED AS AN ASSIGNMENT FOR NSG6101.
INSTITUTIONAL REVIEW BOARD
FOR THE PROTECTION OF HUMAN SUBJECTS IN RESEARCH
This form is to be used for requesting IRB review for exempt, expedited and full board studies
Please note that handwritten and/or incomplete forms will be returned to you.
CHECKLIST FOR IRB APPLICATION SUBMISSION
(to be completed by PI before submission to IRB)
FORMCHECKBOX
Application Form with Signatures/ Confidentiality Agreements
FORMCHECK ...
Delivering Micro-Credentials in Technical and Vocational Education and TrainingAG2 Design
Explore how micro-credentials are transforming Technical and Vocational Education and Training (TVET) with this comprehensive slide deck. Discover what micro-credentials are, their importance in TVET, the advantages they offer, and the insights from industry experts. Additionally, learn about the top software applications available for creating and managing micro-credentials. This presentation also includes valuable resources and a discussion on the future of these specialised certifications.
For more detailed information on delivering micro-credentials in TVET, visit this https://tvettrainer.com/delivering-micro-credentials-in-tvet/
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
1. Office of Research
Research Proposal Approval Form (RPAF)
http://research.lakeheadu.ca/index.html
1. Project Information
New Project [ ] Renewal of Existing Project [ ] Submission Deadline:
Letter of Intent/Notice of Intent [ ] Grant [ ] Contract [ ] Fellowship/Award/Prize [ ]
Funder: Electronic Submission[ ]
Paper Submission [ ]Program:
Title of Proposed Project:
Proposed Start Date: _____________________
Proposed End Date: ______________________
Project Key Words (up to 5)
Relationship to Strategic Research Plan Priorities – Please Select Those
Which Apply:
Aboriginal Studies [ ]
Advanced Technology Systems [ ]
Biotechnology & Material Science [ ]
Culture and Society [ ]
Environmental & Resource-based Development, Education, & Policy [ ]
Health Research across the Life Span [ ]
Northern Studies [ ]
2. Principal Investigator
Full Name (Last, First): Appointment Status:
1. Tenured [ ]
2. Tenure-Track [ ]
3. Adjunct [ ] Start/End Dates: ____________________
4. Limited Term [ ] Start/End Dates: ____________________
5. Contract Lecturer [ ] Start/End Dates: ____________________
6. Other – Please Specify:
Department /Academic Unit:
Extension:
E-mail:
Is this Application being submitted through a research centre? Yes [ ] No [ ]
For information on what constitutes a Lakehead University Research Centre:
http://policies.lakeheadu.ca/policy.php?pid=193
If yes, which Centre?
3. Co-Investigator(s) (attach additional page if necessary
Co-investigator 1: Name Address, Institutional Affiliation:
The participation of this co-applicant in the proposal has been confirmed? Yes [ ] No [ ]
1
2. If the proposal is being submitted by a Research Centre/Institute, is this co-investigator a member of that Research Centre/Institute?
Yes [ ] No [ ]
Co-investigator 2: Name Address, Institutional Affiliation:
The participation of this co-applicant in the proposal has been confirmed? Yes [ ] No [ ]
If the proposal is being submitted by a Research Centre/Institute, is this co-investigator a member of that Research Centre/Institute?
Yes [ ] No [ ]
Co-investigator 3: Name Address, Institutional Affiliation:
The participation of this co-applicant in the proposal has been confirmed? Yes [ ] No [ ]
If the proposal is being submitted by a Research Centre/Institute, is this co-investigator a member of that Research Centre/Institute?
Yes [ ] No [ ]
4. Budget Information
Direct Costs
Indirect Costs*
Total Budget
In-kind
$
$
$
$
*Indirect costs (overhead) must be included for all research grants (where this is allowed
by the sponsor), all industrial grants and contracts. For a definition of indirect costs
(overhead) please see:
http://policies.lakeheadu.ca/policy.php?pid=29
Total Support $ Total Support includes “Total Budget” plus in-kind contributions (if applicable)
Will you be supporting Graduate Students through this project? Yes [ ] No [ ]
Maybe [ ]
5. Partner Funds
Are matching Partner funds included in the
Budget?
Yes [ ] No [ ]
If “Yes”, provide a breakdown by source:
Have any of the matching funds or additional Partner funds been leveraged in another application/proposal, or do
you plan to leverage them elsewhere? If so, please provide details:
6. Involvement of other Institutions (complete only if applicable)
Will funds from the proposed activity be sent by Lakehead
to any other institution(s) or organization(s)?
Yes [ ] No [ ]
If “Yes”, please provide details:
Will funds from the proposed activity be sent by any other
institution(s) or organization(s) to Lakehead?
Yes [ ] No [ ]
If “Yes”, please provide details:
If you answered “Yes” for either of the above questions, an Inter-Institutional Agreement will be required (for more
information, please contact the Office of Research)
If this application is being submitted through another university, are any commitments (financial or otherwise) being
made by Lakehead University by signing off on this submission? Yes [ ] No [ ]
If “Yes”, please specify:
2
3. 7. Regulatory Requirements and other Information
Please indicate if any of the following apply to the proposed research activity:
Yes [ ] No [ ] Live, Non-Human Vertebrate Animals and Animal Tissues (conducted on or off campus). If “Yes”,
Lakehead University Animal Care Committee certification is required before funding will be released.
Please attach certification if available.
Yes [ ] No [ ] Human Participants, Human Tissue/Fluids, observational recording and Secondary Data not in
the public domain (conducted on or off campus). If “Yes”, certification from the Lakehead University
Research Ethics Board is required before funding will be released. Please attach certification if available.
Yes [ ] No [ ] Biohazards. If “Yes”, please contact Tiffany Moore, Bio-Safety Specialist, at tiffany.moore@lakeheadu.ca
for approvals. Once approval is obtained, please forward to the Office of Research. This certification is
required before funding will be released.
Yes [ ] No [ ] Radioactive Materials. If “Yes”, please contact Tiffany Moore, Bio-Safety Specialist, at
tiffany.moore@lakeheadu.ca for approvals. Once approval is obtained, please forward to the Office of
Research. This certification is required before funding will be released.
Yes [ ] No [ ]
Environmental Impact (also required for fieldwork). If “Yes”, please complete Appendices A and B of
NSERC Form 101 (http://www.nserc-crsng.gc.ca/OnlineServices-ServicesEnLigne/Forms-
Formulaires_eng.asp) or the SSHRC equivalent at: https://webapps.nserc.ca/SSHRC/faces/logon.jsp?
lang=en_CA
Attach completed form to this checklist and submit it to the Office of Research.
Yes [ ] No [ ] Does this research proposal involve the use of, or will any resulting publication involve a disclosure or
transfer of information or technology, considered to be subject to the controls or restrictions imposed
under the Export and Imports Permits Act (including the Export Control List, and the Area Control List)
or contain any information subject to the Defence Production Act or the Controlled Goods
Regulations, as administered by the Canadian Controlled Goods Program (NSERC’s policy on Research
Involving Controlled Information can be found at: http://www.nserc-crsng.gc.ca/NSERC-
CRSNG/Policies-Politiques/certaintypes-typescertaines_eng.asp).
If you selected “Yes” please contact the Office of Research immediately.
Yes [ ] No [ ] Is there a conflict of interest (real or potential) involving any of the Investigators involved in this
proposal? If “Yes”, please attach an explanation.
Yes [ ]
No [ ]
Maybe [ ]
Does this project have a possible commercial application?
If you selected “Yes” or “Maybe”, someone from the Innovation Management Office may contact you or
you may also call 807-343-8184 or 807-343-8793 for more information.
8. Other Requirements
Is Release Time being requested as part of the proposal? Yes [ ] No [ ]
If “Yes”, please complete the Release Time Stipend Approval Form and attach it to this document.
Is new construction, equipment installation, or renovations required? Yes [ ] No [ ]
If “Yes”, please provide an estimate of the total costs from Physical Plant. Attach a separate page if necessary.
Is additional space required? Yes [ ] No [ ]
If “Yes”, please attach a description of what arrangements you have made.
Will you be using any of the following facilities to carry out this project: the Lakehead University Centre for Analytical
Services (LUCAS), University Instrumentation Laboratory, Greenhouse, LU-CARIS, Paleo-DNA Lab, Forest Soils Lab,
Science Shop, Civil Engineering Structural Laboratory or Mechanical Engineering Machine Shop and/or other
departmental laboratories?
Yes [ ] No [ ]
If “Yes”, please complete Use of Facilities Form and attach to this checklist.
3
4. 9. Investigator’s Undertaking
• This application is submitted in compliance with the Sponsor’s conditions and published University policies and
procedures.
• The research shall be performed and administered in accordance with the Sponsor’s terms and conditions and the
University’s policies and procedures.
• All staff and students engaged on the project shall be fully informed of, and agree to be bound by, the award conditions.
• I accept responsibility for any over expenditure on the award as the Principal Investigator of the project.
• I understand that neither I nor any staff or students engaged on the project may undertake research with humans,
animals, biohazardous agents, or radioactive materials without the prior written approval of the appropriate University
ethics committee.
• I will be responsible for administering the grant, in accordance with these terms and conditions and will have primary
signing authority (up to $5,000).
• If funds are awarded, I authorize ________________________________, co-applicant, to also have signing authority of up to $2,500 on
the research account.
Signature of Principal Investigator: _____________________________________________________ Date: __________________
10. Approvals(Required for all Applications)
11. Approval Requirements for Adjunct Professor Appointments
(attach additional copies of this page if needed)
12. Research Centre-Initiated Applications
4
Chair’s/Director’s signature: ____________________________________ Date: ____________________________
Dean’s signature: __________________________________________________ Date: ____________________________
If the PI or any co-applicants are adjunct professors at Lakehead University, and are employed with another
organization, the signature of that organization’s authorized representative/CEO is required:
Name: ________________________________________________ Title: _________________________________________________________
Signature: _________________________________________ Date: _______________
5. If you are submitting this application through a University-based Research Centre or Institute, this
Research Proposal Approval Form must be signed by the Centre’s/Institute’s Director.
13. Office of Research
Date Proposal Received: __________ On or before internal deadline? Yes [ ] No [ ]
Comments:
Office of Research Signing Authority
The University will administer the project in accordance with i) its guidelines and policies; ii) terms and conditions of
the agreement/sponsor guidelines.
Signature of the Manager, Office of Research: __________________________________________________ Date:__________________________
5
I certify that this project falls within the stipulated mission and mandate of the Research
Centre/Institute and meets the following criteria to be eligible to receive a centre-initiated
overhead allocation:
-The research project involves at least three or more Lakehead University full-time faculty members from our Research Centre/Institute.
-The research proposal/project is within the stipulated mission and mandate of the Research Centre/Institute.
- By completing the relevant sections of the Lakehead University Research Proposal Approval Form, the principal investigator and his/her
affiliated School or Department and Faculty have endorsed the project as a Research Centre/Institute initiated project.
Director of Centre/Institute:_______________________________________________ Date: ______________________________________
If this proposal is being submitted through a University-based Research Centre or Institute, the signatures of the Departmental Chair (or
Director) and Faculty Dean signifies their approval of a funding mechanism in which the 40% of the overhead revenues generated by a
research project will be distributed in the following manner. When a research proposal is initiated by a Research Centre/Institute, the
distribution policy will be 30% to the Research Centre/Institute and 10% to the Faculty/Department with which the Principal Research
Investigator is associated.
Please note that Lakehead’s Research Programs/Initiatives that have not been officially approved by Senate as University Centres/Institutes
will not be eligible for this new funding mechanism (effective for new proposals submitted after April 1, 2009).
Chair’s/Director’s signature: _______________________________________________ Date: ______________________________________
Dean’s signature: ___________________________________________________________ Date: ______________________________________
Vice-President Research Approval
[ ] Approved as eligible to receive centre-initiated overhead allocation
Signature:___________________________________________________________________ Date: _____________________________________
6. If you are submitting this application through a University-based Research Centre or Institute, this
Research Proposal Approval Form must be signed by the Centre’s/Institute’s Director.
13. Office of Research
Date Proposal Received: __________ On or before internal deadline? Yes [ ] No [ ]
Comments:
Office of Research Signing Authority
The University will administer the project in accordance with i) its guidelines and policies; ii) terms and conditions of
the agreement/sponsor guidelines.
Signature of the Manager, Office of Research: __________________________________________________ Date:__________________________
5
I certify that this project falls within the stipulated mission and mandate of the Research
Centre/Institute and meets the following criteria to be eligible to receive a centre-initiated
overhead allocation:
-The research project involves at least three or more Lakehead University full-time faculty members from our Research Centre/Institute.
-The research proposal/project is within the stipulated mission and mandate of the Research Centre/Institute.
- By completing the relevant sections of the Lakehead University Research Proposal Approval Form, the principal investigator and his/her
affiliated School or Department and Faculty have endorsed the project as a Research Centre/Institute initiated project.
Director of Centre/Institute:_______________________________________________ Date: ______________________________________
If this proposal is being submitted through a University-based Research Centre or Institute, the signatures of the Departmental Chair (or
Director) and Faculty Dean signifies their approval of a funding mechanism in which the 40% of the overhead revenues generated by a
research project will be distributed in the following manner. When a research proposal is initiated by a Research Centre/Institute, the
distribution policy will be 30% to the Research Centre/Institute and 10% to the Faculty/Department with which the Principal Research
Investigator is associated.
Please note that Lakehead’s Research Programs/Initiatives that have not been officially approved by Senate as University Centres/Institutes
will not be eligible for this new funding mechanism (effective for new proposals submitted after April 1, 2009).
Chair’s/Director’s signature: _______________________________________________ Date: ______________________________________
Dean’s signature: ___________________________________________________________ Date: ______________________________________
Vice-President Research Approval
[ ] Approved as eligible to receive centre-initiated overhead allocation
Signature:___________________________________________________________________ Date: _____________________________________
![Office of Research
Research Proposal Approval Form (RPAF)
http://research.lakeheadu.ca/index.html
1. Project Information
New Project [ ] Renewal of Existing Project [ ] Submission Deadline:
Letter of Intent/Notice of Intent [ ] Grant [ ] Contract [ ] Fellowship/Award/Prize [ ]
Funder: Electronic Submission[ ]
Paper Submission [ ]Program:
Title of Proposed Project:
Proposed Start Date: _____________________
Proposed End Date: ______________________
Project Key Words (up to 5)
Relationship to Strategic Research Plan Priorities – Please Select Those
Which Apply:
Aboriginal Studies [ ]
Advanced Technology Systems [ ]
Biotechnology & Material Science [ ]
Culture and Society [ ]
Environmental & Resource-based Development, Education, & Policy [ ]
Health Research across the Life Span [ ]
Northern Studies [ ]
2. Principal Investigator
Full Name (Last, First): Appointment Status:
1. Tenured [ ]
2. Tenure-Track [ ]
3. Adjunct [ ] Start/End Dates: ____________________
4. Limited Term [ ] Start/End Dates: ____________________
5. Contract Lecturer [ ] Start/End Dates: ____________________
6. Other – Please Specify:
Department /Academic Unit:
Extension:
E-mail:
Is this Application being submitted through a research centre? Yes [ ] No [ ]
For information on what constitutes a Lakehead University Research Centre:
http://policies.lakeheadu.ca/policy.php?pid=193
If yes, which Centre?
3. Co-Investigator(s) (attach additional page if necessary
Co-investigator 1: Name Address, Institutional Affiliation:
The participation of this co-applicant in the proposal has been confirmed? Yes [ ] No [ ]
1](https://image.slidesharecdn.com/researchproposalapprovalformrpaf-130719123126-phpapp02/85/Research-proposal-approval-form-rpaf-1-320.jpg)
![If the proposal is being submitted by a Research Centre/Institute, is this co-investigator a member of that Research Centre/Institute?
Yes [ ] No [ ]
Co-investigator 2: Name Address, Institutional Affiliation:
The participation of this co-applicant in the proposal has been confirmed? Yes [ ] No [ ]
If the proposal is being submitted by a Research Centre/Institute, is this co-investigator a member of that Research Centre/Institute?
Yes [ ] No [ ]
Co-investigator 3: Name Address, Institutional Affiliation:
The participation of this co-applicant in the proposal has been confirmed? Yes [ ] No [ ]
If the proposal is being submitted by a Research Centre/Institute, is this co-investigator a member of that Research Centre/Institute?
Yes [ ] No [ ]
4. Budget Information
Direct Costs
Indirect Costs*
Total Budget
In-kind
$
$
$
$
*Indirect costs (overhead) must be included for all research grants (where this is allowed
by the sponsor), all industrial grants and contracts. For a definition of indirect costs
(overhead) please see:
http://policies.lakeheadu.ca/policy.php?pid=29
Total Support $ Total Support includes “Total Budget” plus in-kind contributions (if applicable)
Will you be supporting Graduate Students through this project? Yes [ ] No [ ]
Maybe [ ]
5. Partner Funds
Are matching Partner funds included in the
Budget?
Yes [ ] No [ ]
If “Yes”, provide a breakdown by source:
Have any of the matching funds or additional Partner funds been leveraged in another application/proposal, or do
you plan to leverage them elsewhere? If so, please provide details:
6. Involvement of other Institutions (complete only if applicable)
Will funds from the proposed activity be sent by Lakehead
to any other institution(s) or organization(s)?
Yes [ ] No [ ]
If “Yes”, please provide details:
Will funds from the proposed activity be sent by any other
institution(s) or organization(s) to Lakehead?
Yes [ ] No [ ]
If “Yes”, please provide details:
If you answered “Yes” for either of the above questions, an Inter-Institutional Agreement will be required (for more
information, please contact the Office of Research)
If this application is being submitted through another university, are any commitments (financial or otherwise) being
made by Lakehead University by signing off on this submission? Yes [ ] No [ ]
If “Yes”, please specify:
2](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)