Instructions: Type your information in the shaded boxes and insert an “X” in the applicable checkboxes. Incomplete forms will delay the IRB review process and may be returned.
SECTION A: Investigators & Research Team
A1. Principal Investigator (P.I.):
Name:
Degree(s):
Title/Position:
Program:
Contact Numbers:
Physical Address:
MyCampus Email:
SECTION B: Research Information
B1: Title
B2: Introduction
Please provide a brief (350-500 word) summary of your research project, including background and rationale for your study. Be sure to include in your description what kinds of data you are planning to collect as part of your research (e.g., surveys, interviews, observations, etc.).
SECTION C: Review Type
C1. Does the study involve greater than minimal risk? (Minimal risk means that the probability and magnitude of harm or discomfort anticipated in the research are not greater in and of themselves than those ordinarily encountered in daily life or during the performance of routine physical or psychological examinations or tests. More than minimal risk will require Full Committee Review.)
Place an “X” next to the appropriate response.
[__] Low/Minimal Risk [__] Greater Than Minimal Risk
C2. Which level of review do you believe best matches your research (Exempt, Expedited, or Full)? For more information, view the categories on the APUS IRB Website.
[__] a. Exempt
[__] b. Expedited
[__] c. Full Board Review
SECTION D: Project Purpose/ Research Question/ Objectives
In non-technical language, address the following:
1) Topic and scope of the study.
2) Research questions or hypothesis.
3) How this study will contribute to knowledge in the field.
1)
2)
3)
SECTION E: Participant Population and Recruitment
E1. In non-technical language, address the following:
1) Who will the participants be? How many participants? What ages will the participants be?
2) What is the inclusion/exclusion criteria for participants?
3) Where and how participants will be recruited?
1)
2)
3)
E2. This study will involve participants with the following characteristics (place an “X” next to all that apply):
[__] a. Not Applicable (e.g., de-identified datasets)
OR
[__] Individuals who cannot read/speak English
[__] Individuals living outside of the United States
[__] Students of PI or Research Team Members
[__] Students to be recruited in their educational setting (i.e. in class or at school)
[__] Staff, Faculty, or Students
[__] Minors/Children
[__] Prisoners
[__] Individuals with diagnosable psychological disorders
[__] Individuals who are institutionalized
[__] Individuals who are poor/uninsured
[__] Pregnant women
[__] Fetuses
[__] Nursing home residents recruited in the nursing home
[__] Individuals who are cognitively impaired
[__] Individuals who are psychiatrically impaired
[__] Limited or non-readers
[__] Wards of the state (e.g., foster children)
[__] Individuals who are terminally ill
[__] Others vulnerable to coercion (Specify below):
[__] Other (Specify below):
SECTION F: Research Design
In non-technical language, address the following:
1) State the study activities in chronological order. Describe both the activities conducted by members of the research team and the activities of research participants. (e.g., screening, survey, taking a test, answering questions in an interview, completing a specific task, tasks on a computer, running on a treadmill, debriefing, etc.) If videotaping, photographs, or audio-taping will take place, explain how and why recording will occur.
2) Explain how the data will be analyzed or studied; that is, indicate the quantitative or qualitative data analysis methods you will use.
3) Explain how the data will be reported in order to maintain the confidentiality or anonymity of participants (i.e. aggregated, anonymously, names used with consent, participants only identified by professional role, etc.).
1)
2)
3)
SECTION G: Data Collection
This study involves the following types of data collection (place an “X” next to all that apply)…
[__] Email Questionnaire(s)
[__] In-person Interview(s)
[__] Phone Interview(s)
[__] Video Interview(s) (e.g. Skype, FaceTime, etc.)
[__] Paper Survey(s)
[__] Online Survey(s) (e.g. Survey Monkey, Kwik Surveys, etc.)
[__]Audio-recording
[__]Video-recording
[__] Photography
[__] Existing datasets
[__] Focus Groups
[__] Internet research, (e.g. collecting data via the internet or researching individuals’ behavior on the internet)
[__] Observations
[__] Questions that might result in identifying criminal activities
[__] Questions that might result in identifying child or elder abuse
[__] Review of academic records
[__] Review of medical records
[__] Exposure to psychological stress
[__] Use of physiological sensors (e.g. heart rate, skin conductance, BP)
[__] Physical exercise
[__] Collection of blood or biological specimens
[__] Genetic Material
[__] Diagnostic imaging (e.g., MRI, fMRI, X-Rays, etc.)
