THE UNIVERSITY OF WEST FLORIDA
APPLICATION TO INSTITUTIONAL REVIEW BOARD
FOR HUMAN RESEARCH PARTICIPANTS PROTECTION
The University of West Florida is committed to complying with 45 CFR Part 46, Protection of Human Research Participants and the UWF IRB for Human Research Participants Protection Policy and Procedures. All investigators proposing the use of human research participants in research are required to complete this application and secure approval from the IRB for Human Research Participants Protection.
prior to beginning research. Please complete both parts of the following form and attach a copy of the proposed study, questionnaire or survey (if applicable) and informed consent form. Submit all materials to the dropbox in Elearning for instructor feedback and further direction.
Project Director: / E-Mail:
Department: / Telephone:
Mailing Address (including Zip):
Co-Project Director: / Dr. Trudi Gaines / E-Mail: /
Department: / School of Education / Telephone:
Mailing Address (including Zip): / 11000 University Pkwy, Building 85 PensacolaFL32514
Project Title:
Project is for: / Faculty Research Thesis Dissertation Class Project
Human Research Participation
Dates: / From: / To:
Funding Agency (if applicable): / Account No.
Primary Location of Study:
Signature Approvals:
Project Director / Date / Co-Director / Date
Student Advisor / Date / Department Head / Date
Review Process:
Exempt from IRB Review / Expedited Review / Full Committee Review
Reviewer(s):
IRB Decision:
Approved / Approved Conditionally / Disapproved / Deferred
Comments:
Date:
IRB-APP Rev. 2/24/2003
IRB-APP Rev. 2/24/2003
RESEARCH OBJECTIVES:Concisely describe the goals of this research project.
PARTICIPANTS RECRUITMENT:Describe the sources of potential human research participants, where and how participants will be obtained, selection criteria, number needed, and any targeted characteristics of the participants (children, minorities, gender, etc.).
CONFIDENTIALITY OF DATA:Explain how data will be secured to safeguard confidentiality. Confidentiality is critical if information will be obtained about sensitive or illegal behavior.
METHOD AND PROCEDURES:Explain the methods and procedures of your study.
RISKS TO PARTICIPANTS:Describe in detail any immediate or long range risks to participants that may arise from the procedures used in the study. Indicate whether these risks are greater than those faced in normal life. Detail the precautions to be taken to minimize these risks. (Risks may be physical, psychological, social, economic or legal).
INFORMED CONSENT:Describe the manner in which informed consent will be obtained. Attach a copy of the informed consent form (see IRB-IC - Guidelines for Writing Informed Consent Documents). The informed consent form must be written at a level that the research participants will understand; avoid jargon and use simple language.
IRB-APP Rev. 2/24/2003
THE UNIVERSITY OF WEST FLORIDA
Human RESEARCH PARTICIPANTs USE in Research training ATTESTATION
Name
CollegeUniversity of WestFlorida
DepartmentSchool of Education
Phone
This is to certify that I have read the following documents:
1. The Belmont Report (
2. UWF IRB Policies and Procedures
and have completed the Protection of Human Research Participants computer-based training course from the National Institutes of Health (NIH) available at:
on:
Date
OR
have completed the Human Subject Assurance Training course from the Office of Human Research Protections (OHRP) at:
Date
Please attach a copy of your completed certificate to this attestation.
SignatureDate
Institutional Review Board for Human SubjectsPolicy and Procedures