SAMPLE
THE UNIVERSITY OF ALABAMA IN HUNTSVILLE
INSTITUTIONAL REVIEW BOARD APPLICATION
FORM 1
SAMPLE
Principal Investigator/Study Director:
Name:
Status: Faculty ____Staff ____Student ____
Department: College/Research Center:
Telephone:Email:
Title of Study: The Perception of Citizenship by XYZ methods’ students. Henceforth this group is defined as “pre-service XYZ” because it is my assumption that all will complete their XYZ program and enter the workforce at some point in the future.
Purpose of Study: Gather data about XYZ's perceptions of what it means to be a “good citizen.”
Hypotheses: The primary goal of ABC education is to teach citizenship. In order for XYZ's to teach citizenship, they should have some concept as to what it means to be a good citizen.
Description of Subjects:Undergraduate students in COURSE AWESOME at the University of Alabama in Huntsville and students from four sections of WOO HOO CLASSat the University of Someplace Else campus. Because all of these courses are taught to juniors and seniors in college, NONE of the participants are under the age of 19.
How Subjects Will Be Selected: All class members will be asked to write their perceptions of what it means to be a good citizen. Participation will be voluntary and students who chose not to participate will not be penalized in any way.
Description of Procedure: Simple data collection of voluntary essays/paragraphs. In my classes, I will ask students to respond to the statement “What does it mean to be a good citizen”? The students will be asked to sign an informed consent document which states that participation in the study is entirely voluntary and that no identifying information will be collected with their responses. The data (i.e., essays) will be collected one time at the beginning of the each semester. The data collection will take approximately 10-15 minutes for the participants to compose the essay/paragraph.
Instrumentation:Students will answer the question “What does it mean to be a good citizen?”
Duration of Study:
a. Total amount of time with each subject:10-15 minutes
b. Time to complete study: Spring, summer, and fall semester 2009
Benefit(s) of the Study: To elucidate some common themes regarding XYZ majors’ perceptions of what it means to be a good citizen.
Possible Risks to Subject(s) and Precautions Taken to Avoid Risks:___No risks are anticipated beyond the time taken to complete the written assignment. To avoid any possibility of risks, participation will be voluntary and students will not be penalized if they choose not to participate in the study.
Confidentiality/Anonymity: Data will be collected anonymously__X____
Documentation of Informed Consent by Subject(s) Attached? Yes __X__No ____
Signature: ______
Supervising Faculty Signature (if student):______
SAMPLE