Wichita State University Institutional Review Board (IRB)
RTTJuly 14
IRB Number:
Name of Principal Investigator(s):
E-Mail Address: Campus Box: Phone:
1. Please select ALL that apply:
Research was completed as planned.
Research was never initiated.
No research participants were ever enrolled (or participant records, specimens, etc. obtained).
Research has been discontinued, and there will be no further data collection (including long term follow-up or re-
contact) or analysis of identifiable/coded data. If analysis of identifiable/coded data is ongoing, complete
a continuing review application.
Principal Investigator is leaving the University.
Other, specify:
2. Total Number of Subjects Enrolled
3. Have all research subjects signed the consent form approved by the IRB?
Yes No, explain in the box at the bottom N/A
4. Were there any unexpected adverse events and/or unanticipated problems experienced by subjects?
Yes, explain in the box at the bottom No N/A
5. Discuss what will happen to the identifiable/coded data, if any, at the end of the study. Primary research
data should be retained for a minimum of five years after final project closeout (i.e., no further data
collection, long term follow-up, re-contact, or analysis of identifiable/coded data.)
data were not collected
Identifiers will be permanently removed from the data and destroyed (resulting in de
-identified data)
Identifiable or coded/linked data will be retained and stored securely (as app
If you answered Noto #3 or “Yes” to #4 above, please explain:
PI Signature: Date:
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