Institutional Review Board Application

Please complete the following information for IRB approval. Please note the attachments that will be required for upload below before beginning the application.聽

If you have questions about this process or form, please contact the Director of Institutional Planning and Assessment:

Brad Fricks
Phone: 256-228-6001 X 2330
Email: fricksb@nacc.edu

Name of Principal Investigator*

Investigator Email*

Investigator Phone Number*

College/University Affiliation*

Department/Division*

Name of Supervisor

Supervisor E-mail

Status of Principal Investigator*

Community Member

Doctoral Student

Faculty Member

Other

If Other, please explain:

Title of Study*

Length of IRB Approval Requested (maximum IRB approval is 12 months after which a renewal is required)*

Does your study involve collection of data from a vulnerable population?*

Yes

Does your study involve deception or research in which the subject is purposely led to have false beliefs or assumptions?*

Yes

If your study involves risk to subjects, is the risk greater than that incurred in ordinary educational settings?*

Yes

Is this application a revised application from a previous NACC IRB review?*

Yes

Is this study being reviewed by an IRB at another institution?*

Yes

Describe the purpose of the research. Include major hypotheses and research designs. If the study is a part of a larger study, briefly describe the larger study and whether it also has IRB approval. Please provide the information in an attached pdf file.

Describe the human subjects to be used in the study and their selection criteria. Describe procedures used to ensure the selection of subjects was equitable. Please attach any letters, flyers, advertisements, etc., used to solicit potential subjects. Please provide the information in an attached pdf file.

Describe research procedures and include copies of questionnaires, interview scripts, and protocols, etc. Please provide the information in an attached pdf file.

Describe any potential benefits or harms to the research subjects. Describe whether the study has the potential to expose the participants to stress, physical or psychological hazard, or the possibility of pain, injury, discomfort, embarrassment, worry, or anxiety. Please provide the information in an attached pdf file.

Describe methods proposed to ensure confidentiality and anonymity for subjects. Include, where appropriate, any data coding systems that may be used. Please provide the information in an attached pdf file.

If applicable, provide the following: 1) a description of debriefing procedures to be used in cases where deception has occurred, 2) a statement describing what actions you will take should the research reveal the possibility of a medical or other potentially troubling condition. Please provide the information in an attached pdf file.

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