ࡱ> xzw ybjbjWW 4==)8@\)(Lttttccc^(`(`(`(`(`(`($+c.b(ccccc(tt})%%%c<tt^(%c^(%%~''t:<'J()0)',. .'.'cc%ccccc((%ccc)cccc.ccccccccc : 鶹ý University Institutional Review Board Office of the Vice-Provost for Academic Programs 400 Magnolia Street Orangeburg, South Carolina 29115 Email:  HYPERLINK "mailto:IRB@鶹ý.edu" IRB@鶹ý.edu Investigators Checklist for IRB Submission Please make sure that your application is complete prior to submitting it to the IRB. Please be particularly certain that your consent form (or consent procedure) includes all of the information listed below. Submit application to  HYPERLINK "mailto:IRB@claflin.edu" IRB@claflin.edu, with a single signed hard copy sent to the Office of the Vice-Provost for Academic Programs. The emailed application must be received no later than three week before an IRB meeting to be considered at that meeting, except for student research application, which must be submitted two weeks before the desired decision date. Final approval will not be granted before receipt of the aforementioned hard copy. Application: & Completed and signed Proposal Submission Form & Protocol Summary (5 page limit: identifies research question; describes methods) & Data collection instruments (must coincide with parts of study described in protocol) & Recruitment materials (as applicable) & Consent document (or rationale for deviation from written consent if research is not exempt) & Certificate of training in protection of human subjects:  HYPERLINK "http://phrp.nihtraining.com/users/login.php" http://phrp.nihtraining.com/users/login.php Consent Form: (Written for a lay audience) & Identification of researcher s position, institution & Consent form and date & Description of study (appropriate for lay audience) & Description of procedure (activities, duration: audio or videotaping) & Statement of benefits and risks (even if there are no direct benefits or known risks, explain precautions if there are risks, monetary payment does not constitute a benefit) & Statement of voluntary nature of participation (including the right to skip questions) & Statement of confidentiality (rationale if deviate from complete anonymity; may include waiver to use names of respondents; specify how data will be used) & [Studies using audio, photographic, or video recordings] Explanation of use of recordings and release information Explain use of recording Explain plan for storage Explain how information will be disseminated, if applicable & Contact persons (PI, Claflin Sponsor (if external researcher) & Copy of consent form given to respondent with included statement:  If you have questions about your rights as a participant in this study, you may contact the Office of the Vice-Provost for Academic Programs, whose office oversees the protection of human research participants at (803-535-5447) & Signatures and date 鶹ý University Institutional Review Board Proposal Submission Form Office of the Vice-Provost for Academic Programs 400 Magnolia Street Orangeburg, South Carolina 29115 Email:  HYPERLINK "mailto:IRB@鶹ý.edu" IRB@鶹ý.edu DATE OF SUBMISSION FOR OFFICE USE ONLYNumberReview Type:Exempt & Expedited & Full&PR Proposal type: & Original & Revised Proposal TitleClick here to enter text.Proposed start dateClick here to enter text.Anticipated of duration of researchClick here to enter text. Type of Research: & Claflin Student/Classroom project & Claflin faculty project & Claflin staff project & External researcher project Investigators (please attach additional investigators as necessary): Principal Investigator (for student research, faculty advisor is the PI) Name: Click here to enter text. Department: Click here to enter text. Phone: Click here to enter text. Email: Click here to enter text. University Affiliation: Click here to enter text. Co-Investigator (including student researchers): Name: Click here to enter text. Department: Click here to enter text. Phone: Click here to enter text. Email: Click here to enter text. University Affiliation: Click here to enter text. Co-Investigator (including student researchers): Name: Click here to enter text. Department: Click here to enter text. Phone: Click here to enter text. Email: Click here to enter text. University Affiliation: Click here to enter text. 鶹ý Sponsor (If the researcher is not affiliated with 鶹ý): Name: Click here to enter text. Department: Click here to enter text. Phone: Click here to enter text. Email: Click here to enter text. University Affiliation: Click here to enter text. Data Sources Number of participants: Click here to enter text. How this number was determined (e.g. power analysis). Click here to enter text. Does this project require the collection of new data? & Yes &No If Yes: How will participant be selected or recruited?Click here to enter text. Will subjects participate on a fully voluntary basis? & Yes & No Will subjects be compensated for their participation? &Yes &No If yes: Please describe briefly the compensation: Click here to enter text. Does this project make use of human tissue or cell lines? &Yes &No Briefly describe the research methodology(ies) to be used in this study(e.g. focus group, participant observation, survey, experiment). Click here to enter text. Does this project use data that have already been collected for a non-research purpose or by another researcher? &Yes &No If yes: What is the source of the data? Click here to enter text. Are the data accessible in the public domain? &Yes &No If No: Are fields included that would allow identification of individuals, either directly or indirectly? &Yes &No If yes: Please explain briefly how participant confidentiality will be safeguarded: Click here to enter text. Participant Risks Will participants be exposed to any stresses (e.g. anxiety, pain, etc.) or physical harm (e.g. injury, infection, etc.) in connection with this research? &Yes &No If yes: Please briefly explain what risks may be involved in the research, what specific steps will be taken to minimize and monitor the risk, and what will be done to compensate and/or treat participants who are harmed by the research: Click here to enter text. 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