Copy the following form and add the required information. Add space as needed. Please provide thorough answers for each item. If an item is irrelevant to the research proposal, please enter "Not Applicable." Please submit the completed form (along with supporting materials, such as informed consent form and copies of instruments being used) via e-mail to the chair of the Human Subject Research Committee. In addition to electronic submission, please provide the chair with a hard copy of the cover page information (Title of project, Principal Investigator, Date, Faculty Advisor-if appropriate, Signatures).
Institutional Review Board Lynchburg College
Request for Full Review
Title of Project:
Principal Investigator:
Date:
To the best of my knowledge, the proposed research complies with the conditions described in the statement "Human Subject Research at Lynchburg College," signed:
Principal Investigator _________________________________
Date_________________________
Faculty Advisor _________________________________
(required if the principal investigator is a student)
Date__________________________
Research Proposal: Full Review
1. Briefly describe the proposed project and explain the purpose(s) of the research.
2. Please describe how participants will be obtained (e.g. local businesses, college classroom, etc.) and how human subject information will be collected (experiment, observation, telephone survey, questionnaire, etc...). Please attach a copy of any instrument(s) that will be used and describe the procedures that will be followed. If the information will be collected verbally, provide a list of all questions that will be used.
3. Are subjects being selected for any specific characteristics, e.g., sex, age, ethnic origin, religion, social and economic characteristics, or disabilities? If so, please provide a rationale and justification for the selection process.
4. Are there any foreseeable risks or discomforts to the subjects? ("Risk" means exposure to the possibility of physical or psychological harm; see Human Subject Research Statement, "Protection against harm"). If so, describe the nature and magnitude of these risks.
5. What potential benefits justify the risks or discomfort, and what steps have been taken to minimize the risks or discomfort?
6. What is the approximate number of subjects who will be involved in the research?
7. What is the expected duration of an individual subject's participation?
8. Identify and describe any procedures that are experimental.
9. If any risk of physical or psychological harm exists, describe any medical or professional treatment and compensation that will be available. Also explain how a subject may obtain such information.
10. Describe the extent to which confidentiality or anonymity of subjects will be maintained and how, both during the data collection and after the research is completed. What, if any, records may link the subject's identity to the research?
11. Describe any circumstances under which a subject's participation may be ended by the researcher.
12. State specifically what information will be provided to the subject about the research. (Provide copies of any and all written materials that will be provided to subjects.)
13. Will the research involve any deception of subjects? If so, describe and justify the deception.
14. State how the subject's consent will be obtained. (Please attach consent form.)
15. Will any of the subjects be minors? If so, how will the assent be obtained from the minor? How will consent be obtained from the parents or guardians? (Please attach parental consent and child assent forms.)
Additional comments relevant to request for review: