IRB Application questionnaire
Project Title: ________________________________________
- Provide background information for the study including the objective of the proposed research, purpose, research question, hypothesis and other information deemed relevant.
- Describe the research design of the study (i.e., state whether the study is correlational, experimental, etc. and define the variables).
- Describe the tasks that participants will be asked to perform including a step‑by‑step description of the procedures you plan to use with your subjects. Provide the approximate duration of subject participation for each procedure/ instrument and the frequency and setting of each administration. Identify any personnel who will assist with data collection.
***You must submit a copy of each study instrument, including all questionnaires, surveys, protocols for interviews, etc.
***If someone will be assisting with data collection, but is not indicated as a co-investigator or research assistant in this application (i.e. they will be accessing archival data for you) you must submit a letter of approval indicating that they are willing and capable to assist.
- Describe the recruitment procedures. Explain who will approach potential participants and take part in the research study and what will be done to protect the individual’s privacy in this process.
***You must submit a copy of any material used to recruit subjects (e.g., informed consent forms, advertisement, flyers, telephone scripts, verbal recruitment scripts, cover letters, etc.)
- Describe how participants will be debriefed.
***If deception is used, the principal investigator should offer the participant the opportunity to withdraw his/her data after being debriefed, and this information should be included in the debriefing script.
- Where, how long, and in what format (such as paper, digital or electronic media, video, audio or photographic) will data be kept? In addition, describe what security provisions will be taken to protect these data (password protection, encryption, etc).
- Will you place a copy of the consent form or other research study information in the participant’s record such as medical, personal or educational record? No Yes
***If yes, explain why this is necessary.
***This information should be clearly explained in the consent document and/or process.
- Will any record of the subject’s participation in this study be made available to his or her supervisor, teacher, or employer? No Yes
***If yes, please explain why this is necessary
- Describe the anticipated benefits of this research for individual participants in each subject group. If none, state “none”.
- Describe the anticipated benefits of this research for society, and explain how the benefits outweigh the risks.