Institutional Review BoardProposalApplication

Mark an “X” in theappropriatecategory:Director of InstitutionalResearch

NewApplication:GordonCollege

Revision:(HighlightAllChanges)419 CollegeDr.

Reapplication:Barnesville, GA30204

678-359-5108

Principal InvestigatorInformation / (Mark an “X” inOne) / Faculty / Admin/Staff / Student
Name:
Last / First / M.I.
InstitutionalAffiliation: / Division /Department:
Address:
Street
Address:
City / State / ZipCode
PrimaryPhone: / E-mail(required):
Faculty Sponsor /Co-Researcher / (Mark an “X” inOne) / Faculty / Admin/Staff / Student
Name:
Last / First / M.I.
InstitutionalAffiliation: / Division /Department:
Address:
Street
Address:
City / State / ZipCode
PrimaryPhone: / E-mail(required):

Signature ofPrimaryResearcherDate

Your signature indicates that you have read the human subjects information posted on the GordonCollege Human Subjects Review Committee web site and accept responsibility for the research described in this proposal.

Institutional Review BoardProposal Application(continued)

ResearchTitle:
Date you would like to commenceresearch:
Date you expect to complete datacollection:
Date training completed (attach copy of completioncertificate):
Please provide a typed, detailed answer to each of thefollowing:
1. / Please provide a brief problem abstract that describes your study, why it is important toyour discipline, and what you expect tolearn.
2. / Discuss your participant parameters, include the intended number of participants and their demographic descriptions. Discuss why these parameters are important to yourstudy.
3. / Discuss any incentives, follow-up, or compensation to be used with individual participants, including payment, gifts,etc.
4. / Describe your research procedures. This includes participant activities and time commitment, settings and times for data collection, and materials involved (such as questionnaires, tests,etc.)
5. / Discuss any perceived risks to participants during the course of the study or in thefuture.
6. / Discuss the benefits to the participants and to humanity that may be gained from thisstudy.
7. / Discuss any use of deception in your data collectionprocedures.
8. / Discuss your process for obtaining informed consent from research participants or, if minors, their parent(s) or guardian(s). Be certain to include discussions of time, location, andprivacy.
9. / If minors are involved, discuss your procedure for obtaining consent to participate from the minor, in addition to your procedure for obtaining consent to participate from their parent(s) orguardian(s).
10. / Participants must be assured their data is either anonymous or will remain confidential. If the data will be confidential, you must inform research participants that you may not be able to guarantee confidentiality if disclosure should be required by law.Some illegal activities must be reported (e.g. child abuse). When anonymous questionnaires are used by written informed consent is necessary, consent forms may be signed and returned separately. This procedure avoids any possibility of linking names to the data. Does the data to be collected relate to illegal activities? If yes, please explain.
PLEASE NOTE: Applicants may be required to provide a presentation in person to the Human Subjects Review Committee in order to complete the applicationprocess.