Student Proposal Submission Instructions

Studies using Publicly Available Data

Instructions:

  1. Complete the online course:CITI Course in the Protection of Human Research Subjects,available free of charge at When creating your CITI profile, your employee number is requested. If your employee number is not known or if you are not employed by the UT System, you may use any sequence of numbers to satisfy the request for an employee number. Print out your certificate when completed.
  • Students primarily conducting Biomedical Research should complete the following: 8 Core Biomedical modules, 1 Social and Behavioral module, and 2 elective modules (11 total)
  • Students primarily conducting Social and Behavioral Research should complete the following: 8 Core Social and Behavioral modules, 1 Biomedical module, and 2 elective modules (11 total)

Please note: As of February 15, 2009, UT-Committee for the Protection of Human Subjects (CPHS)is no longer accepting new education certificates from NIH, UCLA, UMN, Baylor, or MD Anderson courses as previously permitted. Existing certificates from those institutions are valid until they expire. New or renewing certificates will only be accepted from the online CITI Course in the Protection of Human Research Subjects, or by attending an IRB 101 or IRB 201 course offered by PRIM&R.

  1. Submit a printed copy of the following completed and signed documents to Rebecca Novak in RAS W-210. Regional campus students, please submit to your regional campus staff who will forward to Rebecca in the Research Office.

____Student Proposal Cover Sheet

____Authorship, Publication Plan, and Data Ownership

____Data Handling Procedures

____Certificate of completion from course on protection of human subjects

____Your Proposal

  1. Email your proposal as a Word file to (in addition to submitting the printed copy).
  1. Proposals are reviewed by the Associate Dean for Research for human subjects risks, compliance with HIPAA guidelines, scientific merit, and compliance with relevant UTSPH and UTHSC policies.
  1. Questions regarding procedures or forms should be addressed to Rebecca Novak at (713) 500-9055 or .
  1. Allow approximately 2 weeksfor the review process.
  1. Approval letters to begin your research are sent via email attachment to the student, committee members, the Office of Student Affairs, and the Regional Campus support person (if applicable).

Student Proposal Cover Sheet

Student Name / First Name: / Last Name:
Phone Number
(Area Code & Number) / Day:
Evening:
Student Email / (insert your name)@uth.tmc.edu
Committee Names / CE, Thesis, or Dissertation Chair:
Academic Advisor:
Committee Members:
Degree Program (Circle) / MPH / MS / PhD / DrPH
Campus (Circle) / Austin / Brownsville / Dallas / El Paso / Houston / San Antonio
Proposal Title
Keywords
(Up to four terms)
Funding for Your Project (Circle) / NO YES
If YES, indicate Amount and Source(s):

SIGNATURES

By signing below, you indicate that this research project is not underway and will not begin until the proposal receives approval from the Academic Committee and the Associate Dean for Research.

Student / Date

This research project is approved for scientific merit (All Committee Members must sign. Complete applicable signature lines for your Committee):

CE, Thesis, or Dissertation Chair / Date / Committee Member / Date
Academic Advisor / Date / Committee Member / Date
Committee Member / Date

Office Use Only

Associate Dean for Research / Date
Reviews
□No further review
□CPHS
Date Submitted
Department
HSC-SPH
  • Exempt
  • Expedited
  • Subcommittee
□Other Review / Type of Project
□Systematic Review of the Literature
□Primary Collection of Data
□Secondary Analysis of Data
□Analysis of a Policy or Professional Practice Issue
□Practice-based Culminating Experience / Secondary Analysis Projects - Source of Data
□UTSPH, Faculty Name:

□TMC
□International
□Other

Authorship, Publication Plan, and Data Ownership

Type your response under each item on this form. Print and obtain signatures.

  1. Plans for formal copyrighting of the thesis/dissertation:
  1. Ownership of the data used by the student for research project, if applicable:
  1. Do you plan to publish of the results of the thesis/dissertation? Yes or No. If yes, please explain.
  1. Where co-authorship is appropriate, discuss how the order of authors on the paper will be decided with special attention to first author and senior author positions. Discuss appropriate norms regarding publication and authorship as laid out in the relevant scientific discipline publication manuals and journal where publication may be considered.
  1. Timelines for publication of results from data:
  1. Agreement concerning student-initiated or faculty-initiated publication, and contingencies if the faculty member or student chooses not to publish the results of the study:

We the undersigned have discussed all points listed above and understand the points summarized on this document. This information is a planning tool and not intended as a binding agreement.

Subsequent changes to this understanding will be discussed as needed.

Student DateCE, Thesis, or Dissertation Chair Date

Academic AdvisorDateData Owner, Principal Investigator,Date

orAuthority Person

**The student and Academic Advisor should each keep a copy of this document**

Data Handling Procedures

  1. List the name/title(s) and source(s)/URL(s) of publicly available data used for this research:

Name/Title(s):
Source(s)/URL:
  1. Is it necessary to obtain permission to use this data from any person/agency or oversight group?

(circle answer)

  1. NO
  2. YES – If yes, then stop using this form and retrieve the appropriate forms for projects using: Secondary Analysis with or without Personal Identifiers
  1. Are there personal identifiers in the data being used for this student research project?

(circle answer)

  1. NO
  2. YES – If yes, then stop using this form and retrieve the appropriate forms for projects using: Secondary Analysis of Data with Personal Identifiers

I have discussed all points listed above with my CE, Thesis, or Dissertation Chair and understand the points summarized on this document.

Student Date