Revised Forms Now Available!

Notice: Revised forms are now available from the links below and are marked with "*". Previous versions of these forms will be accepted through March 5, 2010. After that date, please use only the revised versions.

Application Forms

NOTE: Because changes will be made on a routine basis, forms must be downloaded prior to each use.  Hand-written copies of applications will not be accepted.  Original signatures must be on at least one copy of paperwork submitted to the IRB office. 

INITIAL APPLICATION FORMS

• Determination of Human Research Worksheet*
• IRB Application Form
  Please use this application for Full Board, Expedited and Exempt Studies.
• Certificate of Confidentiality (if applicable)

• Appendix A -- Protocol Description
• Appendix B -- Student as Principal Investigator
• Appendix C -- International Research Review Form
• New Research Project Application Supplement for DoD Research

CONSENT FORM DOCUMENTS

• Informed Consent Template
• Informed Consent Form - Required Elements
  Information required by Federal Law to be provided in the Informed Consent Form.
• Information Sheet for Consent to Participate in a Research Study
• Assent Template
• Debriefing Template

ANNUAL REVIEW FORM/PROGRESS REPORT

• Continuing Review Form

  This form is for annual continuing review purposes.

MODIFICATION FORM

• Modification Form
  Form for all amendments and revisions.

PROTOCOL DEVIATION FORM

• Protocol Deviation Form

CONFLICT OF INTEREST

• Conflict of Interest Disclosure Form
• Examples of Conflicts of Interest

UNANTICIPATED PROBLEM

• Unanticipated Problem*
  Form for reporting all unanticipated problems (ex: subject recruitment issues, compensation to participants, inclusion/exclusion criteria, costs to participants, informed consent issues, documentation of informed consent, privacy or confidentiality protections, vulnerable subject protections, etc.).

HIPAA FORMS

• Authorization to Use or Disclose Protected Health Information for Research