Institutional Review Board (IRB) Proposal Form
(Please print and fill out)


Project Title:


Professor overseeing the research:_____________________________


1. Name(s) _________________________________________________


2. Date ____________________________________________________


3. Type of Review Requested (check one) : Tier 1 ___Tier 2 ___
(Tier 1 involves research that in the professional judgment of the department involved entails no clear potential for harm to any of the human participants. Tier 2 research involves a procedure that poses some imaginable danger to at least one human participant, no matter how unlikely the realization of that danger might seem.)


4. Describe the research protocol or procedure, emphasizing how human subjects will be used. Use additional sheets as attachments if necessary:






5. Given your and your department’s review of this proposal, what potential threats to the rights of human subjects do you think potentially exist?






6. Describe the form you plan to use to obtain informed consent or attach a copy to this proposal.






7. Describe the instrument(s) to be used to collect data. In the case of surveys or questionnaires, attach copies to this proposal.






8. Will deception be used in this research? If so, please describe it further.






9. Describe your plan for debriefing subjects. If you do not plan a debriefing session, please explain why.






10. Provide any additional information or attachments that may be useful to the IRB in evaluating both the potential threats to and protections afforded human subjects in this research.






11. Provide signatures of all researchers responsible for this project: