Provide a memo that includes the following items:
• Describe the project and its purpose.
• Describe the protocol, including number of subjects, how they will be solicited, data sources (such as
interviews, existing data, grades, focus groups, etc.), informed consent procedures and debriefin
g
p
rocedures.
• Explain the experimental methods to be used including what measures or observations will be made, all
sources of data (interviews, existing data such as grades, focus groups, etc.).
• Explain how the data will be kept confidential, including length of time, plans for publication, and how the
original documents/tapes will be destroyed.
Attach copies of the following:
1. Consent form
2. Emails, letters, or flyers soliciting participants
3. Surveys or questionnaires, if applicable
4. Interview or focus group questions, if applicable
5. Prior IRB approval notification, if applicable
Responsibilities of the Principal Investigat
or:
Any additions or changes in procedures in the protocol will be submitted to the IRB for written approval prior to
these changes being implemented.
Any problems connected with the use of human subjects one the project has begun must be communicated to the
IRB Chair.
The principal investigator is responsible for retaining informed consent documents for a period of three years after
the project.
I certify that the protocol and method of obtaining informed consent as approved by the JCC Institutional Review
Board will be followed during the period covered by this research project. Any future changes to the research
project will be submitted to the IRB for review and approval prior to implementation.
_________________________________ _____________
Principal Investigator/Project Director signature Date
_________________________________ _____________
Co-investigator Signature (if appropriate) Date
_____________
__
______________________________
JCC Vice-President (if applicable)
Date
FOR IRB USE ONLY
Project Identification Number: Year:
Approved Approved with restrictions Tabled Disapproved
Determination:
Exempt Expedited Full Review
_________________________________________________
__________________
Signature of IRB Committee Chair Date
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