FINAL REPORT FOR RESEARCH
Upon completion of your research project, fill out this form and submit one electronic copy to HSRB@hendrix.edu AND one signed
paper copy (with original signatures) to the mailbox of the HSRB Co-Chair (Dr. Lindsay Kennedy, DWR 140).
#:
Project Title:
Investigator(s):
(if student research):
Department:
(If the research was not completed as planned, please explain. Use extra pages, if
necessary.):
Faculty Research
Class Assignment
Thesis
Independent
Did you receive Research Funds?
Yes No
utside financial support (e.g.,
grant money)?(If YES, name the funding source.)
Participant Information:
Projected number of participants as approved by HSRB:
Participant Interaction
Age Category:
Records Only
13-17 years
6-12
5
Yes
No
Did any participant suffer any unanticipated or serious
adverse event? (If YES, explain on separate sheet and attach.)
Signature:
I understand I received HSRB approval for this project and time-frame. If I want to continue this project
or a new project, I must reapply and receive HSRB approval again.
__________________________________________
_________________________
__________________________________________
_________________________
Data was collected from:
Total number of participants from whom data was collected:
Before beginning this form, please make sure you are using the most recent version of Adobe Acrobat and can save your entries.
Was your research an NIH-funded clinical trial?
(
If YES, please submit confirmation of results reporting)
Yes No
Yes No
