Collaborating Individual Investigator S Agreement

Collaborating Individual Investigator’s Agreement

Collaborating Individual Investigator’s Name:

Collaborating Individual Investigator’s Institution (if applicable):

I am a Collaborating Individual Investigator in the following Research being conducted by the University of Illinois at Urbana-Champaign (Illinois):

Title of Research:

Illinois Protocol Number:

Illinois Principal Investigator:

I acknowledge and agree that the University of Illinois at Urbana-Champaign Principal Investigator will direct and supervise my research activities outside the Illinois campus.

I have reviewed the following documents: (a) The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research, available at (b) the U.S. Department of Health and Human Services (HHS) regulations for the Protection of Human Subjects at 45 CFR part 46; and (c) the terms of Illinois’s FWA; and (d) the Illinois policies and procedures for the protection of human subjects, available at I understand and accept my responsibility to comply with the standards and requirements set forth in the above-identified documents and to protect the rights and welfare of human subjects involved in the Research.

I will comply with all applicable international, federal, state, and local laws, regulations and policies that may provide additional protection for human subjects participating in the Research.

I will abide by all determinations of the Illinois Institutional Review Board (IRB) and will accept the final authority and decisions of the IRB, including but not limited to directives to terminate participation in the Research.

I will complete any educational training required by Illinois and the IRB prior to initiating activities related to the Research.

I will not enroll subjects in the Research prior to its review and approval by the IRB.

I will report promptly to the IRB any proposed changes in the Research. I will not initiate changes in the Research without prior IRB review and approval, except where necessary to eliminate apparent immediate hazards to subjects.

When responsible for enrolling subjects, I will obtain, document and maintain records of informed consent for each such subject or each subject’s legally authorized representative as required by HHS regulations at 45 CFR part 46 and as described in the Research protocol approved by the IRB.

I will report immediately to the IRB any unanticipated problems involving risks to subjects or others in the Research.

I acknowledge the IRB’s responsibility for initial and continuing review, recordkeeping, reporting, and certification for the Research. I will cooperate fully with the IRB and will provide all information requested by the IRB in a timely fashion.

I acknowledge my responsibility for safeguarding the rights and welfare of each Research subject and that the subject’s rights and welfare must take precedence over the goals and requirements of the Research.

Collaborating Individual Investigator’s Signature: ______Date: ______

Printed Name: Degrees:

Complete Address:

Collaborating Investigator’s Institution (if applicable): The Collaborating Individual Investigator employed by Institution is authorized to conduct the Research at this Institution under the terms of this Agreement.

By: Date:

Authorized Institutional Signatory

Printed Name:

Complete Address:

For Illinois

By: ______Date ______

Susan A. Martinis, Ph.D; Interim Vice Chancellor for Research

Office of Vice Chancellor for Research

601 E John Street

Champaign, IL 61820

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