Forms, Templates & Samples

Forms (for Paper Submissions Only)

The following forms are to be used only when submitting study material to the IRB via paper submission (hand carry or sent through the mail). Please note that these forms may not be used with the new InfoEd process (see below for forms associated with InfoEd).

Contact the IRB office at 6-8802 with questions regarding which form should be submitted.

Applications Download Additional Information
IRB Face Page (file w/ each submission)
IRB-1 — Protocol Application
IRB-2 — Re-Approval/Completion
IRB-5 — Request for Exemption
IRB-9 — Protocol Application for Ethnographic/Naturalistic Research
Appendix A — Personnel and Study Investigators Log/Personnel Amendment Form

 

Supplemental Forms Download (if applicable) Additional Information
IRB-1A — Drug/Device
IRB-1B — Genetic Testing
IRB-1C — Treatment
Cumulative Inclusion Enrollment Report

 

Additional Forms Download Additional Information
IRB-3 — Amendments
IRB-4 — Adverse Event/Unanticipated Event
IRB-6 — Protocol Deviation Report

 

Research Method Course Forms Download Additional Information
IRB-7 — Protocol Application
IRB-8 — Re-Approval / Completion

 

IRB Reviewer Checklists Download Additional Information
IRB-1 — New Submission Protocol Application Checklist
Re-Approval/Continuing Review Checklist
Amendment Review Checklist


Forms (for InfoEd Submissions Only)

The following study protocol forms are to be used together with the IRB-1, IRB-5, IRB-7, IRB-9 protocol application forms when submitting study material to the IRB using the new InfoEd submission process implemented on June 16, 2014. Please note that these forms may not be used with paper submissions (Click here for forms used with paper submissions).

Contact the IRB office at 6-8802 with questions regarding which form should be submitted.

Applications Download Additional Information
IRB-1 — Study Protocol
IRB-5 — Request for Exemption Study Protocol
IRB-7 — Research Methods Course Study Protocol
IRB-9 — Ethnographic/Naturalistic Research Study Protocol

Supplemental Forms Download (if applicable) Additional Information
Cumulative Inclusion Enrollment Report


Please note that the following application forms are now electronic and must be completed online through InfoEd:

  • Appendix A
  • IRB-1A
  • IRB-1B
  • IRB-1C
  • IRB-2
  • IRB-3
  • IRB-4
  • IRB-6
  • IRB-8
  • The Face Page is no longer required for InfoEd submission.


Templates

The IRB recommends the use of these Templates to help the researchers meet the legal requirements for consent.  If after reviewing the templates and samples provided, you believe that the templates are inappropriate for your research, please call the IRB Office for assistance. For additional information about informed consent, see the Consent Checklist and Guidelines; Consent Process.

 

Consent Form Download Additional Information
Annotated Form with Instructions and Suggested Language
Just the Form/Required Language
Consent Form Check List

 

Information Sheet Download Additional Information
Annotated Form with Instructions and Suggested Language
Just the Form/Required Language
For Surveys
By Faculty-researcher
By Student- researcher

Research Method Courses Download Information
Information Sheets
One student - one project
Multiple students – same project
Faculty Review Sheet, to aid in the review of student projects

 

Parent/Guardian Permission Forms Download Additional Information
Parental Permission Annotated Form with Instruction and Suggested Language
Just the Form/Required Language

 

Parent/Guardian Notification Forms Download Additional Information
Parental Notification Annotated Form with Instructions and Suggested Language
Just the Form/Required Langauge

 

Recruitment Flyer Download Additional Information
Sample Recruitment Flyer Template (with tabs)

 

Photo and Video Release Download Additional Information
Release Form


Samples

Examples of Child Assents, a recommended description of Deception for Consent Forms and an example of a Consent Form before and after the language was simplified appear below. For help with Consent Forms, come to the IRB Help sessions or call the IRB Office for an appointment. 860-486-8802 / 486-9428.

 

Assents Download Additional Information
Sample 1
Sample 2