ࡱ>  H7bjbj{{ =__|-O|R \ hhh|||8 |-!2"(Z"p"p"p"*" "Z-\-\-\-\-\-\-$194-h"p"p"""-hhp"p"-###"dhp"hp"Z-#"Z-##r+T^,F#|B,F--0-P,4#44^,4h^,""#"""""--#4"""-""""4"""""""""X : MORAVIAN UNIVERSITY INSTITUTIONAL REVIEW BOARD (IRB) PROPOSAL FORM This form must be completed for any research activity involving human participants, unless the proposer is claiming exemption from the IRB review process. All researchers should review the ΢ƽ Human Participants Research Policy found at  HYPERLINK "/irb" /irb before submitting their proposals. Please fill out this form completely and follow the submission instructions below. Failure to submit all necessary documents will delay the IRB review of your research proposal. Proposal Review Timetable: Proposals are accepted on a rolling basis. Note that during the standard academic year, it typically takes a minimum of 2-3 weeks for the committee to review and respond to completed proposals (longer during summer). Most proposals require some modifications before receiving approval. The revision process typically adds an additional 1-2 weeks to the review process. Submit electronic copies of all of the following to  HYPERLINK "mailto:hsirb@moravian.edu" hsirb@moravian.edu: 1. This completed ΢ƽ Institutional Review Board (IRB) Proposal Form. Please make sure all required information is complete. Your IRB form should be submitted as a Word or pdf document (we will not approve Google Drive documents or other kinds of documents that can be changed during the review process). 2. A copy of your Informed Consent form and/or other evidence of informed consent (Word documents are preferred for consent/assent forms). The readability level of your consent or assent documents should be appropriate to your target participants. If you are recruiting from the general adult population, a reading level of around 8th grade is recommended. 3. CITI training certificates for all researchers listed on the proposal, unless already on file. The appropriate CITI training modules are listed  HYPERLINK "/irb/citi" here. 4. A copy of all instruments (surveys, tests, etc.) and supplemental materials. If you are showing pictures or videos, a copy of these need to be submitted as well. You may provide links if the material will be accessible online. Recruitment materials (e.g., flyer, email text) should also be included. You can combine the documents in one file or submit separate files as email attachments, but please make sure the file name clearly indicates the section of the overall proposal and the author. E.g., Johnson Proposal Form.docx and Johnson Informed Consent.docx. The preferred format for all materials is Word or PDF. We understand that some materials may only be available in other formats but make every effort to use one of those formats. Questions? Contact an Executive board member: Dr. Sarah Johnson, Department of Psychology:  HYPERLINK "mailto:johnsons@moravian.edu" \h johnsons@moravian.edu Dr. Debra Wetcher-Hendricks, Department of Sociology:  HYPERLINK "mailto:wetcherhendricksd@moravian.edu" \h wetcherhendricksd@moravian.edu Dr. David Wilkenfeld, Department of Rehabilitation Sciences:  HYPERLINK "mailto:wilkenfeldd@moravian.edu" \h wilkenfeldd@moravian.edu Part I: RESEARCHER 1. Proposer/Principal Investigator (PI)one primary contact with whom the IRB will correspond: Is the PI a student? Y N 2. Department/Affiliation of PI: 3. E-mail address of PI: 4. Phone of PI: 5. Faculty Advisor name and department (if PI is student): 6. Names and Departments or Affiliations of all co-investigators (Please place an asterisk next to the names of any students listed.): 7. Conflicts of Interest: Please review the  HYPERLINK "/irb" list of current IRB members here. Identify any members of the IRB committee that you believe may have a conflict of interest with your project and list those individuals here: 8. Title of Proposal: 9. This is a (please check): _____ New Proposal _____ Resubmission of a rejected Proposal _____ Renewal _____ Request for modification10. Research Dates: Format as month, day, year. Your proposed start date should be at least 3 weeks after the date you submit your proposal. Proposed start date: Proposed end date:  11. CITI certification is (please check all that apply): _____ Attached for (list relevant names): _____ Already on file with IRB for (list relevant names):  Part II: PROPOSAL TYPE (General research information) Read the list of exemption categories for research that is exempt from IRB review, listed on the MU IRB website,  HYPERLINK "/irb" /irb. If you feel your project might fit one of these exemption categories, you should fill out the  HYPERLINK "/content/hsirb-exemption-request-form" IRB Request for Exemption form, instead of this proposal form. If you are uncertain if your research fits one of these categories, you can discuss your situation with a member of the IRB Executive Board. If your research does not fit into one of the exemption categories, check the statement below. _____ I have looked over the exemption categories and the proposed study does not fall under any of those categories. 5. Funding sources/Compensation a. List the research funding sources, if any. b. Is compensation being provided to participants? If so, briefly describe and state the source of the compensation funds. 6. The results of this research will be published. _____ Yes _____ No _____ Uncertain If you marked yes or uncertain, please provide a brief description of the possible forum of publication (for example, peer-reviewed journal, conference presentation, etc.) Description of publication forum: Part III. DETAILS OF THE RESEARCH PROJECT In this next section, you will provide extensive details about the research project. Please make sure that your explanations/descriptions are clearly written and grammatically correct so that the committee can accurately follow and assess your proposal. In this section, please address each of the following subheadings separately using the separate boxes provided. It is okay to repeat information (succinctly) if there is overlap across sub-sections. Objectives (i.e., overall research question/goal): Design (i.e., a brief description of the general type of research being conducted): Procedures (i.e., a longer description of the detailed plans for the research, including timing of key research events, recruitment, data collection, etc. Make sure you clearly describe what is required of the participants during the research): Outline procedures/steps to reduce risks to participants: ATTACHED DOCUMENTS: Please check below to indicate any documents you are including with your proposal (including all supplementary materials): Please check all that apply (this should be a complete list of the documents you are including): _____ Proposal form _____ Informed consent form _____ Debriefing statement _____ Surveys/questionnaires/inventories (list all that are included): _____ Stimuli (pictures, videos, text documents, etc.; list all that are included): _____ Letters of support (list all that are included): _____ Other (please list): This research intentionally recruits one of the following GROUP(S) vulnerable to risk. Check all that apply. _____ Participants under the age of 18 _____ Prisoners _____ Pregnant women _____ People with mental, cognitive, intellectual, or physical disabilities 2a. If you checked any of the groups identified above, explain why you need to use the group(s) and the methods you will use to minimize risks. If your research design poses no special risks to these vulnerable individuals in your sample, please state this and explain why. 3. If your research does not intentionally include one of the groups listed in question 2, but you are working with a volunteer sample, so the possibility exists for vulnerable individuals to be in your sample, you must answer this question (if you did answer question 2, you can skip this question). Think carefully about whether your research project could adversely affect someone with any of these vulnerabilities. Consider whether you might try to screen out these individuals. If you are using a screening process, explain it below. If not, explain the methods you will use to minimize the risks to these individuals. 4. Are there any other vulnerabilities apart from those listed above that might be a concern in your research (for example, allergies, people taking certain medications, etc.)? If yes, describe the concern and explain how you will minimize the risks to those individuals. 5. Describe your participant pool including: the intended number of participants participant characteristics/demographics 6. Describe in detail the methods you will use to recruit your participants. 7. This research involves deception of participants. _____ Yes _____ No If you checked Yes, describe the nature of the deception and your debriefing procedure. You will need to provide the debriefing statement with the full proposal submission. Even if the debriefing will be done orally, you need to submit the text of the verbal statement that will be read to participants. 8. Explain by whom and how the participants will be informed of the purposes of this research project. State how consent will be given by the participant (i.e., written, spoken, or implied). (Remember to provide a copy of the informed consent form with this proposal form.) Research Design Note: Any statements given to participants either orally or in written form (including, but not limited to, informed consent, child assent, or debriefing statements) must be written at a reading level appropriate to the audience. For a general adult audience for whom their reading level is not known, you should shoot for an 8th grade reading level. 9. This research collects information, which (check all that apply) _____ deals with sensitive aspects from the participant's point of view. _____ identifies the participant by name or personally identifying number codes (e.g., ID or social security number). _____ might place the participant at risk of liability if made public. _____ might place the participant's financial standing or employability at risk if made public. Research Design Note: Think carefully about whether your research deals with topics that the participant may find sensitive. Sometimes it is not obvious to the researcher that the topic of their research may be sensitive from a participants point of view. If you checked any of the categories above, please address parts a, b, and c below (all three are required). Explain the methods you will use to: a. safeguard the data you collect (you need to describe this safeguarding procedure in detail, including but not limited to a description of how the data will be protected (for example, in a locked cabinet or on a password-protected computer), who will have access to the data, and how and when the data will be destroyed. b. inform participants of available support services (If your participants are drawn from the ΢ƽ community, please provide contact information for the Moravian Counseling Center, Campus Safety and the Health Center. For participants drawn from other communities, please provide the comparable support service information.) If you are not able to provide support services information, explain why not. c. minimize the risk of identification of participants.  All investigators on the proposal must have a CITI certificate filed with the IRB. Please submit CITI certificates as SEPARATE files from any other proposal documents. 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