Application for Extension of Research Project
The IRB mandates that all approved research extended longer than one calendar year complete an extension of research project application. Please complete the application below and email it to the IRB Chairperson and Administrator.
A copy of the informed consent form must be included with the continuation application unless a waiver of consent was granted in the original application.
Identifying Information
1. Title of proposed research and IRB number
2. Principal Investigator’s Contact Information:
Name:
Mailing Address:
Daytime Phone:
E-mail Address:
Status: Faculty Staff Student
3. Additional Investigators:
Name / Phone Number / E-mail Address4. Briefly describe the progress on the completion of the study (including the number of participants enrolled since the last approval, any difficulties noted in recruiting or retaining participants during the just completed approval period, the approximate number of participants who have refused participation, the number of participants who have voluntarily withdrawn from the study prior to completion, and any unexpected reactions, findings, or complications in the study since the last approval).
5. Approximately how many more participants will be required to complete the study?
Researcher's Assurance: I certify that the information provided in this application is complete and correct. I understand that as principal researcher, I have ultimate responsibility for the conduct of the study, adherence to ethical standards, and protection of the rights and welfare of human participants as outlined in the Belmont Report. I agree to: (1) Conduct the study according to the approved protocol; (2) Make no changes to the approved study without prior IRB approval; (3) Use the approved procedure and form(s) for obtaining informed consent; and, (4) Promptly report any significant adverse events to the IRB within 5 working days of occurrence.
______Researcher's Signature / ______
Printed Name / ______Date
Faculty Advisor/Sponsor's Assurance: By my signature, I certify that the student or guest researcher has sufficient knowledge to conduct the study in keeping with the protection of human participants. Further, I agree to: (1) monitor study progress; (2) Supervise the researcher in solving problems in the research as they arise; (3) Ensure that the researcher promptly report significant adverse events; (4) Identify an alternate advisor or sponsor in the event that I am unavailable (on leave or sabbatical) and advise the IRB in writing of such arrangements.
______Faculty Advisor/Sponsor's Signature / ______Printed Name / ______Date