Full Review Application
Institutional Review Board
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If another IRB is involved in your project, you may attach copies of the IRB application and of the IRB
approval letter from the participating institution in lieu of completing this form.
Title of Research Project _______________________________________________________________
Principal Investigator/
Project Director
Student Investigator
Student Investigator
Phone Ext.
Anticipated Funding Source (if applicable):
Projected Duration of Research: months Projected Starting Date:
Other organizations and/or agencies, if any, involved in the study:
Please return this form with:
A memo that briefly answers the questions outlined on the next page.
Grant application, if applicable.
All brochures, advertisements, or recruitment materials to be given to subjects.
A completed copy of the Consent Form Checklist
A copy of the Consent Form that will be provided to the participants.
I. Project Information:
A. Project Activity Status:
New Project
Periodic Review of Continuing Project
Revision to Previously Approved Project
B. This project involves Henry Ford College students
Yes No
C. Human Subjects from the following populations will be involved in this study
Minors High School Students
Mentally Disabled Prisoners
Elderly None of the above
D. Total number of subjects to be studied:
Clear Form
Full Review Application
Institutional Review Board
Pg. 2
Attach a document containing brief answers to the following questions.
II. Protocol:
What is the rationale or purpose of the study?
Why are you interested in using HFC as a basis in your research?
Who will be the research subjects?
Where will the research take place?
How much time will be required of each subject?
How will you recruit participants?
What methods will you use to gather your data?
Does the study require class time? (Note: using class time is discouraged)
Do you have an internal contact who is already willing to comply?
Attach copies of any recruitment materials and research instruments (exams, surveys,
questionnaires, etc.).
III. Precautions:
How will you ensure that each subject’s participation is voluntary?
If you plan to offer inducement in return for participation, what would that be?
IV. Confidentiality of data:
What methods will you use to ensure the privacy of the participants and confidentiality of data
obtained, including plans for publication, disposition or destruction of data, etc.?
What are your plans for distribution, dissemination, or publication of the data?
V. Consent
What are the potential risks to the participants?
What steps have you taken to minimize risk to the participants?
Attach copies of all consent forms to be signed by the subjects and/or any statements to be
read to the subject.
Responsibilities of the Principal Investigator:
Any additions or changes in procedures in the project will be submitted to the IRB for written
approval prior to these changes being implemented
Any problems connected with the use of human subjects once 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.
The principal investigator should include with the IRB submission a confirmation that the
research has been approved by the HFC chairperson(s) and Dean(s) of the academic area(s)
where the research will be conducted.
Full Review Application
Institutional Review Board
Pg. 3
The principal investigator shall notify the HFC IRB chairperson when the research proposal
has been approved or modified by another institution’s IRB.
The principal investigator will provide a copy of the final research results to the chairperson of
Principal Investigator Signature: Date:
Co-Investigator/Student Signature (if applicable): Date:
Dean/Director Signature Date
Vice President Signature (if applicable) Date
Signature of IRB Committee Chair:
IRB Chair: Check one
Approved with conditions
Requires Periodic Review