Application for Approval to Use Human Subjects Example Completed Applications: Example 1 | Example 2 "*" indicates required fields Name of person completing the form* First Last Email address of person completing the form* Enter Email Confirm Email Application1. How many principal investigator(s), technicians, statisticians, students, etc. are directly involved in this project?* One Two Three Four Five Six Seven Eight Nine Ten Project member's name and title*(John Smith / student researcher)Project member's name and title*(John Smith / student researcher)Project member's name and title*(John Smith / student researcher)Project member's name and title*(John Smith / student researcher)Project member's name and title*(John Smith / student researcher)Project member's name and title*(John Smith / student researcher)Project member's name and title*(John Smith / student researcher)Project member's name and title*(John Smith / student researcher)Project member's name and title*(John Smith / student researcher)Project member's name and title*(John Smith / student researcher)2. College and department*3. Title of project*4. Funding agency (if any)5. Abstract (summary of proposed investigation: include PURPOSE, METHODS, expected RESULTS, and DISCUSSION headers)*6. Projects purposes (hypotheses if applicable)*7. Study design (illustrations, schematics, timeline, groups, interventions, etc.)*8. Describe the proposed participants (age, sex, race, or other special characteristics, such as students in a specific class, etc.)*9. Describe how the participants are to be selected/recruited*10. Describe, in detail, the proposed materials & methods in the project*Any proposed experimental activities that are included in evaluation, research, development, demonstration instruction, study, treatments, debriefing, questionnaires, and similar projects must be described here. 11. Will electrical or mechanical devices be used?* Yes No Please describe the electrical or mechanical devices to be used*12. Will a computer or internet-based method of collecting or transmitting data be employed?* Yes No Please explain how your study will fulfill the principles of voluntary participation and informed consent:*13. Are the benefits of the research greater than the risks to human participants?* Yes, the benefits of the research are greater than the risks. No, the risks to the participants are greater than the benefits of the research. If “No,” please explain*14. Are there any possible emergencies, which might arise in utilization of human subjects in this project?* Yes No Please describe possible emergencies that might arise and what your plan of response would be. Also, what have you done to minimize the probability of any emergency?*15. What provisions will you take for keeping research data confidential?*16. How many researchers (PI’s only) are there?* One Two Three Four Five Researcher's name*Researcher's name*Researcher's name*Researcher's name*Researcher's name*17. Please send the following as files (all documents should be as individual files labeled with the PI’s name, description of the contents, and date submitted) or appendices to the current SAU IRB Chair: PHRP certificate…. Protecting Human Research Participants. Informed Consent form. Subject recruitment advertisements. Questionnaires, etc. Electrical or mechanical equipment specifications/descriptions utilized. Δ
