Form A: Cover Sheet for IRB Project Proposal

All documents should be submitted as one continuous WORD (.doc or .docx)

or RTF format, with the exception of the online human subjects research

training completion certificate (which will be an image or PDF file) and Form A.

  1. The primary investigator should complete and sign Part I of this form, andONE of the following:
  2. Form B—for a project that is exempt from further review
  3. Form C— for a project qualifying forexpeditedreview
  4. Form D— for a project needingfull review.

NOTE:If you aren’t sure which level of review your project requires, use the checklists on Forms B-D to determine this. Generally speaking, anything involving vulnerable individuals or more than minimal risk to participants requires full review; research that uses anonymous data collection, existing published or de-identified data(see IRB website for definition), or involves public officials is exempt. Anything in-between is likely to require an expedited review.

  1. Complete the online human subjects research training on the IRB websiteand include a copy of your successful completion certificate to your application. For more information, see
  2. Submit Form A and Form B, C,or D, depending on the level of review and all required attachments (e.g., human subjects research certificate, instruments (surveys, interview, focus group guides, recruitment scripts,consent forms & statements) to the following persons for review and signatures:
  3. BMC students, faculty & staffand outside researcher principal investigators: your staff/faculty sponsor or advisor, who will signPart II of this form.
  4. All researchers:yourdepartmental reviewer, whowill complete and sign PartIII and forward the application to the IRB Chair.
  5. Paper submissions will not be accepted.
  6. All documents should be submitted by the Departmental Reviewerin one continuous WORD (.doc or .docx) or RTF format, with the exception of the online human subjects researchtraining completion certificate (which will be an image or PDF file) and Form A,which must have a handwritten or an electronic signature—a typed signature does not suffice.See Adobe website for information about creating an electronic signature: Form A may be scanned and saved as a PDF then sent via email.
  7. Projects that qualify for exempt or expedited review may be submitted at any time for review; it should take between two to three weeks for review. The IRB committee discusses research requiring full review at four scheduled meetings each year in October, December, February, and May—exact dates are posted on the IRB website at the start of each semester.

Part I. Primary Investigator Information and Statement of Review Status

Name of Primary Investigator (PI):

E-mail:hone:(000)-000-0000

Mailing address:College mailbox or Dept. Name OR Street, City, State, Zip Code

PI’s affiliation with Bryn Mawr College:
BMC Faculty BMC Staff BMC StudentHaverford Student
Swarthmore Student Other:

If PIisan undergraduate, check any of the following that apply to this research:
Senior thesisMellon Mays Hannah Holborn GrayPollak
Dean’s Research FundLILACOther program: (Please list)

Project title:

Data collection will begin on, and end on

If this research is funded by an external agency (e.g., NSF, NIH), which agency?
Title of the proposal to that agency for funding:

Which human subjects research training have you completed? Please attach a copy of your certificate.

Online NIH training Other (please specify)

In your judgment, what level of IRB review applies to this project?

Exemption from expedited or full committee review (i.e., project meets conditions on Form B)

Expeditedcommittee review (i.e., project meets conditions on Form C)

Full committee review (i.e., project does not meet conditions on Form B or C)

I certify that the statements herein are accurate and complete.I agree to protect the rights andwelfare of the human subjects participating in my research, to abide by College guidelines forsecuring informed consent, to safeguard the confidentiality of my research data, and to inform thechair of the IRB should any changes in the research protocol or human subject issues arise duringthe course of this research.

Part II. Faculty/Staff Advisor or Sponsor Statement of Review Status

Undergraduate researchers and graduate students conducting thesis research must have their faculty advisors review and sign this section before submitting their application it to the IRB chair. PIs who are not affiliated with Bryn Mawr, butarepartnering with Bryn Mawr affiliates or enrolling them as participants in a study must have a Bryn Mawr College sponsor, who should complete this section before an application is submitted to the IRB. If you do not yet have a sponsor, e-mail the IRB chair ().

BMC Faculty/Staff Advisor or Sponsor’s Name:

E-Mail:Phone:

In your judgment, what level of IRB review applies to this project?

Exemption from expedited or full committee review (i.e., project meets conditions on Form B)

Expedited committee review (i.e., project meets conditions on Form C)

Full committee review (i.e., project does not meet conditions on Form B or C)

I have reviewed this application and will oversee this research in its entirety.

Part III. Departmental Reviewer Statement of Review Status

Name of Departmental Reviewer:

E-Mail:Phone:

Date received:

Checklist (all items that must be included in an application –check if present):

NIH Training Certificate

A form

Form B, C, or D

Anything a respondent may see (e.g. recruitment scripts, flyers)

Anything a respondent may complete (instruments—online surveys, interview guides, focus group guides etc.)

Consent form or informed consent statement and/or assent forms

In your judgment, what level of IRB review applies to this project?

Exemption from expedited or full committee review (i.e., project meets conditions on Form B)

Expedited committee review (i.e., project meets conditions on Form C)

Full committee review (i.e., project does not meet conditions on Form B or C)

Sign and forward the completed application to the IRB Chair (). Please do not send any incomplete applications to the Chair.

IRB A Cover Sheet, revised 8/2015page 1 of 3