Revised: 12/22/06
Application for Review of CornellUniversity Training Programs and
CornellUniversity Classes Requiring the Use of Human Subjects in Research
CORNELLUNIVERSITY
University Committee on Human Subjects
Please click in shaded fields to complete form
Project Identification:
Director or Instructor’s name:
Email Address:
Campus Address:
Name of class/training program:
Number of trainees or expected class enrollment:
Date of request:
Have you successfully completed the online UCHS, NIH, or another university’s human subjects training program?
Yes No If not, please complete Cornell’s program immediately. If you have completed another program, please attach a copy of your completion certificate to this form.
Submission Category (please check one)
Training grant involving graduate and/or postgraduate trainees
Class training students how to do research involving human subjects: interviewing, human experiments, coding, focus groups, etc.
Class requiring or encouraging students to conduct research involving human subjects as an assignment
Please answer all of the following questions completely, and include the documents requested in your submission.
- What assignments or tasks involving the use of human subjects are you assigning to students/trainees? If this is a course, include the syllabus. Please describe all assignments as fully as possible if this is not clear from the current syllabus. Examples of past assignments are very useful for this review. If this is a training program, please outline the typical work performed by trainees that may involve use of human subjects.
- What education will the students receive in the conduct of human subjects research at Cornell? Include any relevant information on web-based education, the name sof the textbooks and their content, lectures you give, etc.
3.If this is a class, please explain how teaching assistants (if you have any) will receive training in the use of human subjects.
4.If this is a class, please consult “Conducting classes in research methods and class research projects” on the UCHS web site:
Please note: UCHS requests that students conducting research as a class assignment be instructed NOT to use Cornell staff members as subjects in their projects. Exceptions to this policy must be approved in writing by Mary Opperman, Vice President for Human Resources.
Please provide appropriate signatures on next page.
Signature Page
Class Instructor(s) or Training Program Director(s):
“I will take responsibility for protecting human subjects involved in the research performed by the students and trainees, I will inform the students and trainees of the need for the safekeeping of all raw data (i.e., test protocols, tapes, questionnaires, interview notes, etc.) in a University office or computer file.”
Signature (1) Date
Signature (2)Date
If this is a class, this preliminary proposal must also be signed by the department chair, associate chair, Director of Undergraduate Studies, or Director of Graduate Studies of the home department.
Chair/Director:
"I have examined this completed form and I am satisfied with the adequacy of the protection of human subjects.”
Print Name and TitleSignature
DateOffice Phone