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INSTITUTIONAL REVIEW BOARD (Otterbein College)

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INSTITUTIONAL REVIEW BOARD
Application Forms
Please read the Guidelines for Submission of Protocols carefully prior to completing the attached
materials. Per the Guidelines, determine if your submission is for expedited or complete committee
review. Requests for both full and expedited review must follow the same procedures, with the
exception that a request for expedited review must be indicated on the "Cover Page of Summary
Sheets."
The following materials are required to support the review process of the IRB Committee. Please type.
1.
SUMMARY SHEETS:
a. Cover Page for Summary Sheets must include original signatures of the principal and co-
investigators. (If student, advisor must be listed as principal investigator.)
b. The Summary Sheets include 17 questions regarding subject population, consent procedures,
risks and benefits. Complete each section. Do not leave any question unanswered.aa
aabaaaa.
2. ORAL AND/OR WRITTEN INSTRUCTIONS TO SUBJECTS. Please provide an outline or script of the
information which will be provided to subjects prior to their volunteering to participate. (Please
note: Subjects must be informed about the nature of what is involved as a participant, including a
description of anything they might consider to be unpleasant or a risk.) Include a copy of the
written solicitation and an outline of the oral solicitation when applicable. If you are recruiting by
means of a "sign-up sheet," please attach a copy of that sheet.
3.
CONSENT FORM, IF REQUIRED, SHOULD BE INCLUDED. aab
.Please note that the person obtaining consent shallsign a copy of the cover sheet for
the summary sheets.
4. ALL SUPPLEMENTARY MATERIALS SOLICITATION, INSTRUCTIONS, CONSENT, QUESTIONNAIRES
SUREYSTESTSETC MUST BE SUBMITTED AS HARD COPY, EMAIL ATTACHMENT, OR LIN TO
SHARED FOLDER IN ORDER FOR THE PROPOSAL TO BE EALUATED
Only protocols that are complete as defined below will be scheduled for review. Incomplete protocols will be
returned to the principal investigator.
FOR EXPEDITED REVIEW, SUBMIT A DIGITAL OR HARD COPY OF THE COMPLETE
PROTOCOL – (Summary Sheets including original signatures, oral/ instructions to subjects,
questionnaires-instruments,a consent form) as defined above to:
FOR FULL COMMITTEE REVIEW SUBMIT A DIGITAL COPY OF THE COMPLETE
PROTOCOL – (Summary Sheets including original signatures, oral/ instructions to subjects,
questionnaires-instruments, aconsent form) as defined above to:
Meredith Frey, Chair
Psychology Department
b.
(Updated January 2019)
Otterbein University Office Use:
Institutional Review Board Protocol No.
Date Received:
Cover Page for
SUMMARY SHEETS
aaName Signature
Investigator(s):
A    
PI     
,  
 
 .
aName Signature
aName Signature
PI Academic Title:
a
Department :
Campus Address:
(Faculty Member's Campus Address)
PROPOSAL TITLE:
Are you applying for  review? If so, indicate,awhich best
describes your project.
Is there outside funding for the proposed research? If so, please indicate the source
:
When do you plan to begin collecting data?
When do you plan to finish collecting data
Revised January 201


 
aaaaab

Please select if applicable.
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OTTERBEIN UNIVERSITY INSTITUTIONAL REVIEW BOARD
RESEARCH SUMMARY SHEETS
Be specific about exactly what subjects will experience when they participate in your
research, and about the protections that have been included to safeguard them. Careful
attention to the following may help facilitate the review process.
1. In a sentence or two, describe the background and purpose of the research.
2. Briefly describe each procedure or manipulation to be implemented that will impact
subjects included within the study.
3. What measures or observations will be taken in the study? If any questionnaires, tests, or
other instruments are used, provide a brief description and include a copy for review.
4. Who will be the subjects in this study? How will they be solicited or contacted?
5. What steps will be taken to insure that each subject's participation is voluntary? What, if
any inducements will be offered to the subjects for their participation?
6. If there are any risks involved in the study, are there any offsetting benefits that might
accrue to either the subject or society?
Yes
No
. abab
. bbaa
aaab.
. abbab.
1. bbaaa
b.
11. baab
baab.
12. bbaa
baaa
b.
NA
13a. aa44.11..14a
baa.a
ba.ab.
13b.
 abba
aa
14. aaaa
aaa
aaab
aa
1.
aaaa
aabaaa
baaa
1. bbaaabab
a
1. aaaaaaaba
b.
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INSTITUTIONAL REVIEW BOARD (Otterbein College)

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