*Only students enrolled in research or methodology classes in which students are under the direct supervision of an instructor may consider using this Protocol-Form. Students who are preparing protocols to do limited data-collection or pilot studies may submit abbreviated protocols using this form. All other proposals (master’s projects, theses, dissertations, and faculty research) require the submission of a complete protocol, as described within the document entitled Brief Guidelines for Human Subjects Research, available in the office of the Academic Vice President or of Institutional Research.

Name of Student_____________________________Advisor__________________________

Course#______________________Course Title____________________________________

INSTRUCTIONS:

1. Read the policies of the Human Subjects Review Board (HSRB), as outlined in the Brief Guidelines document. (This document is available from your instructor, department chair, or the office of Institutional Research.)

2. TYPE responses to each of the items below, in the spaces provided, or attach extra printed pages.

3. Prepare any additional required documentation such as an Informed Consent Form, a typewritten copy of Verbal Instructions, a Cover Letter with Instructions, and/or Letters of Permission.

4. Complete an Application for Approval of Research Involving Human Subjects form (Available in the office of the Academic Vice President or of Institutional Research.) and have it signed by your instructor and by your department chairperson.

5. Attach the Application as a cover page to this document, along with any other supporting documents and submit to the office of Institutional Research.

ITEMS REQUIRING A RESPONSE FOR BRIEF RESEARCH PROTOCOL:

1. Brief description of the purpose (the problem statement or hypothesis), the method, and the time-frame of the proposed research.

2. Description of how the research will benefit human subjects, as well as human and/or scientific knowledge.

3. Description as to how the subjects will be involved in the study and for how long.

4. Description of the subjects. (Give the number of subjects involved and list the criteria used in making the decision regarding their inclusion/ exclusion. Indicate whether minors (Under age 18) or other vulnerable populations will be involved.

5. (If applicable) Explain how the welfare and rights of minors or others with restricted competency to give informed-consent are to be protected.

6. Description of the risks and discomforts, if any, to the subjects.

7. Description of how personal privacy is to be protected and how confidentiality is to be maintained. You must be specific.

8. The subjects must be aware that their participation in the study is completely voluntary and that refusal to participate or complete the study will not have negative consequences to them. Explain, here, how the idea of voluntary participation is conveyed to the subjects. You must include information as to how you will deal with communication-barriers--the deaf, the blind, those with language barriers, those with limited ability to understand your intent. (Submit a copy of the Informed Consent Form, or a copy of the Letter of Instructions (for surveys distributed individually), or a Written Copy of Verbal Instructions which will be used in interview or classroom settings.

9. Description of information regarding the researcher’s ethical responsibility to the subjects.

10. If off-campus sites (hospitals, schools, etc.) are to be used for data-collection, please attach letters of permission from an appropriate authority, at these sites, authorizing research.