Application to Use Human Research Subjects - Essay Example

???? ????? Name and Title Dept. Phone, E-mail address 3. Non-key personnel: ????? ????? Name and Title Dept. Phone, E-mail address 7. Consultants: ????? ????? Name and Title Dept. Phone, E-mail address 8. The principal investigator agrees to carry out the proposed project as stated in the application and to promptly report to the Human Subjects Committee any proposed changes and/or unanticipated problems involving risks to subjects or others participating in approved project in accordance with the Liberty Way and the Confidentiality Statement.

The principal investigator has access to copies of 45 CFR 46 and the Belmont Report. The principal investigator agrees to inform the Human Subjects Committee and complete all necessary reports should the principal investigator terminate association with the University. Additionally s/he agrees to maintain records and keep informed consent documents for three years after completion of the project even if the principal investigator terminates association with the University. ___________________________________ _________________________________________ Principal Investigator Signature Date ___________________________________ _________________________________________ Faculty Sponsor (If applicable) Date Submit the original request to: Liberty University Institutional Review Board, CN Suite 1582, 1971 University Blvd.

, Lynchburg, VA 24502. Submit also via email to irb@liberty.edu APPLICATION TO USE HUMAN RESEARCH SUBJECTS 10. This project will be conducted at the following location(s): (please indicate city & state)  Liberty University Campus X Other (Specify): Charlottesville High School: Charlottesville, Virginia 11. This project will involve the following subject types: (check-mark types to be studied) X Normal Volunteers (Age 18-65)  Subjects Incapable Of Giving Consent  In Patients  Prisoners Or Institutionalized Individuals  Out Patients X Minors (Under Age 18)  Patient Controls  Over Age 65  Fetuses  University Students (PSYC Dept.

subject pool __)  Cognitively Disabled  Other Potentially Elevated Risk Populations______  Physically Disabled __________________________________________  Pregnant Women Subjects Incapable of Giving Consent. 12. Do you intend to use LU students, staff or faculty as participants in your study? If you do not intend to use LU participants in your study, please check “no” and proceed directly to item 13. YES  NO X If “Yes”, please list the department and/or classes you hope to enlist and the number of participants you would like to enroll. ????? In order to process your request to use LU subjects, we must ensure that you have contacted the appropriate department and gained permission to collect data from them.

Signature of Department Chair: ___________________________________ ____________________________ Department Chair Signature(s) Date 13. Estimated number of subjects to be enrolled in this protocol: ___15-25____________ 14. Does this project call for: (check-mark all that apply to this study) X Use of Voice, Video, Digital, or Image Recordings?  Subject Compensation? Patients $????? Volunteers $????? Participant Payment Disclosure Form  Advertising For Subjects?  More Than Minimal Risk?  More Than Minimal Psychological Stress?

 Alcohol Consumption? X Confidential Material (questionnaires, photos, etc.)?  Waiver of Informed Consent?  Extra Costs To The Subjects (tests, hospitalization, etc.)?  VO2 Max Exercise?