Application for Approval of Research Involving Human Subjects

Application for Approval of Research Involving Human Subjects

_{Human Subjects Review Board}

_{Southwestern Adventist University}

^{Instructions:}

_{Use this form as a cover-sheet and attach it to the following items:
(1) The appropriate Research Protocol, (2) An Informed Consent Form, (3)
Additional Documentation, as needed - i.e. Cover Letter of Explanation, Sample
Questionnaire, Written Copy of Verbal Instructions, and/or Letters of
Permission. Please submit 2 full sets of the document (NOTE: For Expedited/
Full Review, 12 copies are necessary.) to:}

_{Institutional Research, Southwestern Adventist University, Keene, TX
76059}

_{SWAU FAX Number (817) 556-4744}

_{On-Campus Address: Office of Institutional Research, Findley
Building}

SUGGESTED CATEGORY OF HSRB REVIEW:

The investigator(s) should read, carefully, the Brief Guidelines for Human Subjects Research and discuss with the research-advisor and/or the department chairperson, the relationship of the present research project to the policies and procedures contained in the above-document. After this consultation, the investigator(s) need(s) to request that the research be considered by the Human Subjects Review Board (HSRB) under one of the two categories listed below. Final assignment of the review category is made by the HSRB. The timeline of Board action is also noted.

_____Exempt from Review(5 working days)_____Expedited/Full Review(15 - 30 days)

DESCRIPTION OF RESEARCH PROJECT:

Project Title: ____________________________________________________________________________________________________________________________________________________

Projected Date of Project Completion:_____________________________________________

Location Where Subject-Related Involvement will Occur:_______________________________

SUPPORTING SIGNATURES:

"I have reviewed the above-project with the investigator(s) and concur on the requested category of HSRB review."

_________________________________	_________________________________	________
^{(Name of Advisor, if student project)}	^{(Signature of Supervising Advisor)}	^Date

"This project has been reviewed for research merit and has the academic endorsement of this department. "

_________________________________	_________________________________	________
^{(Academic Department Investigator)}	^{(Signature of Department Chairperson)}	^Date

AGREEMENT OF INVESTIGATOR(S):

^{"I(We) hereby agree to abide by the terms and methodology as
outlined in the attached research protocol. I (We) also agree to begin the
implementation of this project only after written notification of its approval
has been received. Furthermore, I (We) agree that in cases involving
research to be conducted at a non-SWAU site, such research will commence only
after written authorization from an officer of the organization at each site
involved has been filed with Institutional Research. Notification of any
alterations in the attached protocol will be submitted to the Chairperson of the
HSRB."}

_________________________________	_________________________________	________
^{(Name of Principal Investigator)}	^{(Signature of Principal Investigator)}	^Date

ANY ADDITIONAL INVESTIGATORS:

1._________________________________	_________________________________	________
^{(Name of Coinvestigator)}	^{(Signature of Coinvestigator)}	^Date
2._________________________________	_________________________________	________
^{(Name of Coinvestigator)}	^{(Signature of Coinvestigator)}	^Date
3._________________________________	_________________________________	________
^{(Name of Coinvestigator)}	^{(Signature of Coinvestigator)}	^Date
4._________________________________	_________________________________	________
5._________________________________	_________________________________	________

COMMENTS YOU MIGHT CONSIDER USEFUL TO THE HSRB:

__________________________________________________________________

ABSTRACT:

(In 100 words, or less, please provide a brief description of your research project.)

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