For use by researchers who are external to the College
1. Complete this request as an MS Word document using this template. Include electronic samples of survey instruments, directions, and other materials to support your request. Save the document using the following file name: [today’s date] [first initial and last name of PI (principal investigator)]. For example: August 03 2012mname
2. Surveys require an informed consent statement at the top of the instrument. Focus Groups and Interviews require a signed informed consent form for every human subject. You must retain these signed forms for a minimum of five years. Templates for proposal requests and informed consents forms.
3. Upon completion of the research, send a copy of the data and any reports related to the research to email@example.com
5. Please use the following outline as your format. All information requested on the outline MUST be completed. Failure to do so will delay the approval of your proposal.
Outline of data needed in proposal.
Title of Project
Dates of Proposed Project
Sources of Funding
Research Methodology (please list participants, theory, methodology, coding, analytic techniques, plans for interpreting results, and expected results.
Potential Benefits and Anticipated Risks
Informed Consent Process
Principal Investor Signature and date (at end of proposal)
Supervisor’s Signature and date (at end of proposal)
Note: When submitting proposal, attached any blank consent forms you plan to use.
Submit all proposals to: Stephens College IRB – firstname.lastname@example.org.
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