Human Participants Research Approval Form

The guidelines, procedures and a sample participants' written informed consent form are on the Provost's page: http://www.denison.edu/offices/provost/human_subjects_review.html

Please use the Human Participants Approval Form below to incorporate your responses. This form is intended to be used in ways that are responsive to the research methods of your discipline/s. Feel free to use as much space as necessary for each item. Any questions can be directed to Toni King, Associate Provost kingt@denison.edu. Once you hit submit, your completed form will be sent electronically to Jane Dougan in the Provost's Office.

Date

Instructional/Administrative Use, Faculty or Student Researcher Student Box #

Faculty Sponsor(s) (for student research projects)

This form will be forwarded to the faculty sponsor for approval before IRB approval can be completed.

Title of Project

1. Under what auspices is this project being done (i.e., faculty research, administrative research, student research. If student research, please identify as senior research, summer scholar research, independent/ directed study research, course-related research or other - please specify).

2. Give a synopsis of the research project including its purpose.

2 a) Summarize who your participants will be.

2 b) Describe the kinds of engagement or interaction you will have with participants; and/or what will they be asked to do.

2 c) How will the findings be used?

3. Describe how you plan to ensure written or verbal informed consent (see Basic Principles in Guidelines and Policies for Human Participants Research 5a "Informed Consent" for forms of informed consent).

4. Describe how you plan to ensure anonymity and, if not anonymity, confidentiality. Anonymity refers to research in which the identity of the participants is not known to the researcher. Confidentiality ensures that, when the identity of participants is known to the researcher, information about the identity of the participant and information provided by the participant cannot be attributed back to the participant. If neither anonymity nor confidentiality is to be provided or assured, this must be explained to respondents in the informed consent process.

5. Describe any risks or special stresses the participants must undergo, and why they cannot be avoided.

6. Describe any deception involved, and why it cannot be avoided.

7. Data gathering instruments (e.g. surveys, questionnaires, interview questions etc.). Please type or cut and paste your data gathering instrument into the text box below. If you prefer, you may send your survey or questionnaire separately as an MSWord document. When you send your MS word attachment please indicate: "Materials for IRB review" in the subject heading of your e-mail message to expedite action on your submission. Send any attachments to: Jane Dougan (dougan@denison.edu).

Please send:

8. Informed consent document. Below is an example of a standard Denison Sample Written Informed Consent Document. You may use the Denison form in its entirety, tailor it to your research, use a form recommended by your department/discipline, or create one of your own. In cases of verbal consent, as well as consent in ongoing ethnographic projects, a written copy of the process for obtaining initial consent of participants must be submitted to the IRB.

9. Debriefing Statement (refer to Basic Principles in Guidelines for Human Participants Research). Describe how and when participants will be debriefed. If the debriefing will not be carried out in person during the time that the research occurs, explain the reasons for the debriefing method chosen. Please note that the particular relationships between researcher(s) and participants and the context of the research may govern the form of debriefing.

9a. Provide the content that you will include during the debriefing. The following information should be included:

a) the purpose of the investigation

b) the research methodology

c) the general area of research, (e.g., health psychology, organizational sociology)

d) person (s) to whom the participants can turn if they have questions about the research. Please include the name and contact information of the supervising faculty member.

Email all materials to: dougan@denison.edu

DENISON UNIVERSITY CONSENT FORM

My signature on this form confirms that I voluntarily agree to participate in the following survey/research:

Title of Research:

Researcher:

Department:

My signature confirms the following:

1. My participation is voluntary. I understand that I may refuse to participate in this study, not respond to individual questions, or discontinue my participation at any point.

2. I have been assured of confidentiality or anonymity unless I have otherwise given permission to the researcher to be quoted or identified.

3. The overall purpose and uses of the study have been explained to me as indicated below and I have been informed that a fuller debriefing will be made available to me.

[Here the researcher should provide a clear statement describing the overall purpose of this research]

Signature_______________________________________ Date_____________________

(Please note: in the case of minors, the signature of a parent or guardian is needed.)

Gateways

Human Participants Research Approval Form