Application for Review of Cornell University Training Programs And

Revised: 11/09/2007

Application for Review of Cornell University Training Programs and

Cornell University Classes Requiring the Use of Human Participants in Research

CORNELL UNIVERSITY

Institutional Review Board – Human Participants

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 IRB, NIH, or another university’s human participants 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 participants: interviewing, human experiments, coding, focus groups, etc.

Class requiring or encouraging students to conduct research involving human participants as an assignment

Please answer all of the following questions completely, and include the documents requested in your submission.

1.  What assignments or tasks involving the use of human participants 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 participants.

2.  What education will the students receive in the conduct of human participant’s research at Cornell? Include any relevant information on web-based education, the names of 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 participants.

4. If this is a class, please consult “Conducting classes in research methods and class research projects” on the IRB web site: http://www.irb.cornell.edu/forms/undergrads.htm

Please note: IRB 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 participants 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 participants.”

Print Name and Title Signature

Date Office Phone