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IRB Format for Submissions
To: Western New Mexico University Institutional Review Board
Subject: Request for Approval of Project Entitled [Insert your title here]
Name, title or position, phone number, email, and responsible faculty member (if applicant is a student).
If applicant is a student, the Faculty sponsor must complete a Faculty Verification and Sponsorship Form (this needs to be created).
Names of any others who will make contact with human participants. Indicate type of assistant and how and by whom they will be trained and supervised.
Proof of completion of such training must be included for each person who will be involved in data collection, analysis and reporting.
Are you receiving any funding for this research? If so, please explain and provide details.
Will multiple institutions be used to collect data?
State the research problem and aims of the research. Include background literature that helps to place this research in the context of the field. Describe any benefits to participants or to society, including compensation. Also include some information about your intention for public dissemination of your findings.
Participants - Describe the subject population, recruitment activities, and criteria for selection or exclusion. Justify the use of any special populations (e.g., children, prisoners, participants who might have issues that challenge or impair their ability to give consent, pregnant women).
Materials - Summarize instruments (questionnaires, interviews, observations, tests, etc.) and other methods of data recording (notes, audiotapes, videotapes, etc.). All instruments, experimental stimuli and other materials must be submitted in their full and final versions for review. Clear indication of the recording, scoring and intended analysis of data must be described.
Procedures - Provide a concise and complete description of your procedures, taking care to emphasize any and all potential risks and potentially sensitive issues. Address risk-benefit issues; i.e., do the benefits justify the risks? Describe all activities involving the human subject, including duration and frequency of each activity. Consent and debriefing information is requested below.
Consider the following: What information is necessary to insure that consent is adequately “informed”? If individuals with impaired abilities to give consent, such as children, will be used, what manner of assent is appropriate? Note that the term “children” includes anyone under the age of 18 and that Western New Mexico University enrolls a substantial number of students under the age of 18 years as dual enrolled high school students who require parental consent in order to participate in any research study. All proposals that involve students from WNMU must address the following:
In addition, the intended use(s) of the results of the study must include description of how the identities of the students will be protected and any identifying information eliminated if used in publication. Measures to prevent unintended uses of the data collected in the implementation of the study. (Including digital recordings of images and sounds as well as written notes.)
Attach your consent and or assent form. Note: the form must contain the following statement: “If you would like to discuss or comment on any aspect of this project, please contact the WNMU Institutional Review Board care of Academic Affairs at 575-538-6317 or firstname.lastname@example.org”
Describe any procedure or measure to protect the privacy of subjects and to maintain the confidentiality of the data. Describe data handling and storage to insure appropriate use and protection of human participants.
Indicate that you agree to promptly bring to the attention of the IRB any changes in methods or procedures from those described above or any unexpected consequences adversely affecting the subjects.
I have reviewed the protocol and application materials and certify that the proposed study involves no known risks other than those specified. Furthermore, I certify that the protocol procedures conform to the norms, ethical standards, and accepted methods within my discipline, to the best of my knowledge.
Note: if you are submitting as a student, the signature of the faculty/staff mentor with whom you are working/being supervised must be included, and that mentor must also submit a letter of support.