ASM events
This conference is managed by the American Society for Microbiology
Table of contents
No headers

                                                                                                           Institutional Review Board 

1000 Univesity Center Lane 

Lawrenceville, Georgia 30043 

678.407.5xxx 

www.ggc.edu/irb 

email: ggcirb@ggc.edu 

 

Human Subjects Research Form 

For Research with Human Participants 

                                                                                            

 

Title of research:        

 

Date research will begin:        Expected completion date:       

 

If proposal is for external funding: Agency:        Deadline:       

 

You agree that you have read the University's "Assurance of Compliance with HHS Regulations for the Protection of Human Research Participants" and agree to provide for the protection of the rights and welfare of the participants that participate in this research as outlined in the Assurance. You also agree to submit any significant changes in the procedures of your project to the IRB for prior approval. 

 

Name of Investigator(s):         

 

Department (include mail drop #):        

 

 Student  Faculty  Other (please describe)       

 

Phone:        Date:        Email:       

 

FOR RESEARCH CONDUCTED BY STUDENTS OR NON-FACULTY STAFF: This research involving human participants, if approved, will be under the direct supervision of the following faculty advisor: 

 

Faculty Advisor:         

 

Department (include mail drop #):       

 

Phone:        Date:        Email:       

  

1.   Have you submitted research on this topic to the IRB previously?   Yes  No 

If yes, list the date, title, name of investigator, and study number, if known:        

 

2.   Description of research  

 

      a.   Purpose of research:       

 

      b.   Nature of data to be collected:       

 

      c.    Data collection procedures:       

 

      d.   Instruments to be used:       

 

      e.   Method of selection/recruitment of participants:       

 

      f.    Participant age range:            Number:            Sex:       

 

      g.   Incentives, follow-ups, compensation to be used:       

 

3.   Risk.  Describe in detail any psychological, social, legal, economic or physical risk that might occur to participants.  Note that all research entails some level of risk, though perhaps minimal.  

 

       No known risk   Risks include:       

 

4.   Benefit.  University policy requires that risk from participation be outweighed by potential benefits to participants and/or humankind in general.  

 

      a.   Identify benefits to participants resulting from this research:       

 

      b.   Identify benefits to humankind in general resulting from this research:       

 

5.   What is the consent process to be followed in this study?  All studies must include informed consent. Consent may require signature.  Include form(s) to be used. If deception is necessary, please justify and describe, and submit debriefing procedures.        

 

6.   Minors and other vulnerable participants.  If minors or other vulnerable participants are involved, please outline procedures to be used in obtaining their agreement (assent) to participate, in addition to the consent of their authorized representative such as parent or guardian. If you do not wish to include minors, it may be useful to include related language in the cover letter or consent form.        

 

7.   Future risk.  How are participants protected from the potentially harmful future use of the data collected in this research?  

 

      a.   Describe measures planned to ensure anonymity or confidentiality.        

       

      b.   Describe methods for storing data while study is underway.        

 

      c.    List dates and plans for destroying data and media once study has been completed.        

 

      d.   If audio, videotape or other electronic data are to be used, when will they be erased?         

             

8.   Illegal activities:  Do the data to be collected relate to any illegal activities?  Yes  No    

If so, please explain.       


[1] This form was adapted from Kennesaw University’s Institutional Review Board Approval Request Form 

Tag page

Files 2

FileSizeDateAttached by 
 GGC-IRB-submission-form.doc
No description
116 kB12:11, 21 Jun 2012lhammondsodieActions
 GGC IRB SUBMISSIONS REQUIREMENTS.docx
No description
18.48 kB12:11, 21 Jun 2012lhammondsodieActions
Viewing 1 of 1 comments: view all
The attachment titled "GGC IRB Submisssions Requirements" states:
--Documentation of completion of required training (when requested)
You might want to find out now if you are required to complete training so your IRB process is not slowed down because you didn't complete training.
Posted 10:07, 18 Jul 2012
Viewing 1 of 1 comments: view all
You must login to post a comment.