McKendree University
Research Institutional Review Board Form

Date:    

Request for:

     Full IRB Review
     Expedited IRB Review
     Exempt

Title of Research Project:

    

Name and Contact Information:

Faculty Advisor
Phone Number
E-mail

Student Investigator
Phone Number
E-mail
Undergraduate
Graduate







Hypothesis (Quantitative Research only):

    

Purpose of Research:

    

Describe the participants in the study (e.g. gender, race, age, special population group - mentally challenged - if applicable, total number, etc.):

    

Methodology (Please describe briefly the procedure for how the information will be gathered, timeline, etc.):

    

Please describe all measures used in the study (e.g. surveys, instruments, etc. - Please attach all measures to this form):

    

What are the risks and/or benefits to the participants involved?  Minimal risk: a risk is minimal where the probability and magnitude of harm or discomfort anticipated in the proposed research are not greater, in and of themselves, than those ordinarily encountered in daily life or during the performance of routine physical or psychological examinations or tests.

    

What will be done to reduce the risks to the participants and maintain the privacy and confidentiality of the data?

    

Note:  When you create the files below save them with your initials as part of the file id.  Example, jkg-consent-form.doc.

How will you gather informed consent of the participants?  Please attach a copy of the written document or of the verbal announcements of the informed consent:

    

How will participants be debriefed?  Attach the written document or the verbal announcement of the debriefing:

    

Survey:  If you are using a survey, please attach it here:

    

Read and accept the following statement:

I am familiar with the ethical principles on the research with human participants.  I have read the policies for obtaining approval from the institutional review board at McKendree University.  I certify that the information provided on this form is accurate and complete.  I also certify that if the conditions or procedures in this proposal undergo substantial change, I will submit a new form.  I also realize that this form allows me to conduct this research for a time period no longer than two years.  Approval of this research does not remove liability from the responsible investigator.

I accept the agreement       I do not accept the agreement 

Note:  If you do not receive conformation that the data has been sent contact John Graham at 537-6822.