Rev. 6/24/11

REQUEST FOR STUDY NUMBER IN COURSE CREDIT SUBJECT POOL

Email form to:

A. IRB Information

IRB Protocol Number: ______Expiration Date: ______

IRB Proposal Title: ______

Investigator: ______Investigator Email: ______

Responsible Faculty: ______Faculty Email: ______

B. Request Type (Check one):

All requested studies must be already approved by the Campus IRB. The request type chosen below depends on whether they have also been approved already by the Psychology Department Human Subject Committee (HSC) and whether the study has an existing study number in either the Course Credit Subject Pool or the Paid Subject Pool.

All studies using the Course Credit Subject Pool must be approved by the HSC. Amendments to IRB protocols that involve more than changing researcher names and yearly updates must be re-approved by the HSC.

____ Already approved by HSC; existing study # in Course Credit Subject Pool ______

(Attach most recent IRB Approval notice)

____ Already approved by HSC but need new study number in Course Credit Subject Pool

(Attach most recent IRB Approval notice)

____ Already approved by HSC but IRB protocol has been amended. Study has existing study # in

Course Credit Subject Pool ______

(Attach most recent IRB approval notice, completed IRB-1 form (including amendments since last HSC approval), consent forms, debriefing)

____ Not yet approved by HSC but existing study # in Paid Subject Pool ______

(Attach most recent IRB Approval notice, completed IRB-1 form, consent forms, & debriefing)

____ Not yet approved by HSC & no study number in either Course Credit or Paid Subject Pool

(Attach most recent approval notice, completed IRB-1 form, consent forms, debriefing)

C. Study Information

1. Duration of Session (Check One)

____ 1 hr ____ 2 hrs ____ 3 hrs

2. Number of Sessions per Subject (Check One)

____ 1 ____ 2

(If sessions differ in length, please note. The Sona software cannot handle studies with > 2 sessions.)

3. Is this a web study? (Check one)

_____Yes _____No

4. List the researcher(s) who need access to this study number: ______

5. Researcher/s whose subject hour allocations will be used: ______

6. Number of hours from each researcher’s allocation to add to study: ______