Date Received / ORRC Assigned : JG ___ TR ___ AB___
Date: ______
Date of determination: ______
Submission #
INITIAL OR DE NOVO SUBMISSION
ADDITIONALKEY PERSONNEL LIST
11.01.13
Principal Investigator (PI)/Co-Principal Investigator (Co-PI): The PI is the individual who has absolute responsibility for the overall conduct of all activities involving human subjects, including all technical, compliance and administrative aspects.
Who is considered Key Personnel according to IRB? Persons responsible for one or more of the following:
  1. Day-to-day protocol decision-making related to the study conduct;
  2. Participant recruitment, selection and eligibility;
  3. Clarification of the complexities of the protocol to the participant and others;
  4. Collecting participant information and entering data using procedures to maintain privacy and confidentiality;
  5. Ensuring that the rights and welfare of participants are monitored throughout the study.
It is the responsibility of the PI to determine who should be considered “key personnel” based on the above criteria for each study.
ALL “key personnel” listed on IRB applications are required to complete the required CITI training. Note: Copy of CITI Human Subject Training Completion Report must be attached for EACH person listed.
Principal Investigator (PI) Name
PI Email / Phone #:
Protocol Number:
Protocol Title:

Total Number of Personnel on Protocol (including PI and Co-PI)

INVESTIGATOR/PERSONNEL INFORMATION SECTION
Name / Department / UAlbany
Affiliated / Yes No
Affiliation / University at Albany College of Nanoscale Science and Engineering
The Neural Stem Cell Institute Other (specify) : ()
Institution Name
(if not affiliated with UAlbany)
Position / Faculty Staff UAlbany Undergraduate Student
UAlbany Graduate Student Other specify : ()
E-mail Address: / CITI Completion Report Attached? Yes No / ORRC Use ONLY:
Verified :_____
Role in Research
INVESTIGATOR/PERSONNEL INFORMATIONSECTION
Name / Department / UAlbany
Affiliated / Yes No
Affiliation / University at Albany College of Nanoscale Science and Engineering
The Neural Stem Cell Institute Other (specify) : ()
Institution Name
(if not affiliated with UAlbany)
Position / Faculty Staff UAlbany Undergraduate Student
UAlbany Graduate Student Other specify : ()
E-mail Address: / CITI Completion Report Attached? Yes No / ORRC Use ONLY:
Verified :_____
Role in Research
INVESTIGATOR/PERSONNEL INFORMATIONSECTION
Name / Department / UAlbany
Affiliated / Yes No
Affiliation / University at Albany College of Nanoscale Science and Engineering
The Neural Stem Cell Institute Other (specify) : ()
Institution Name
(if not affiliated with UAlbany)
Position / Faculty Staff UAlbany Undergraduate Student
UAlbany Graduate Student Other specify : ()
E-mail Address: / CITI Completion Report Attached? Yes No / ORRC Use ONLY:
Verified :_____
Role in Research
INVESTIGATOR/PERSONNEL INFORMATIONSECTION
Name / Department / UAlbany
Affiliated / Yes No
Affiliation / University at Albany College of Nanoscale Science and Engineering
The Neural Stem Cell Institute Other (specify) : ()
Institution Name
(if not affiliated with UAlbany)
Position / Faculty Staff UAlbany Undergraduate Student
UAlbany Graduate Student Other specify : ()
E-mail Address: / CITI Completion Report Attached? Yes No / ORRC Use ONLY:
Verified :_____
Role in Research
INVESTIGATOR/PERSONNEL INFORMATIONSECTION
Name / Department / UAlbany
Affiliated / Yes No
Affiliation / University at Albany College of Nanoscale Science and Engineering
The Neural Stem Cell Institute Other (specify) : ()
Institution Name
(if not affiliated with UAlbany)
Position / Faculty Staff UAlbany Undergraduate Student
UAlbany Graduate Student Other specify : ()
E-mail Address: / CITI Completion Report Attached? Yes No / ORRC Use ONLY:
Verified :_____
Role in Research