Investigator(s) Information Complete all required sections and submit all attachments. An incomplete IRB form will not be accepted and may cause delays to your study.
Principle Investigator:(Required)
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Investigator Position(Required) BSU - Faculty/Staff BSU - Student
Principle Investigator - CITI Certification(Required) Upload a copy of your valid CITI certification. Student certifications are good for the length of their attendance at the institution. Faculty/Staff certifications are renewed every 5 years.
Additional Investigator 1:
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Investigator Position(Required) BSU - Faculty/Staff NTC - Faculty/Staff BSU - Student NTC - Student Non-BSU/Non-NTC Researcher
Add'l Investigator - CITI Certification(Required) Upload a copy of your valid CITI certification. Student certifications are good for the length of their attendance at the institution. Faculty/Staff certifications are renewed every 5 years.
Additional Investigator 2:
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Investigator Position(Required) BSU - Faculty/Staff BSU - Student
Add'l Investigator - CITI Certification(Required) Upload a copy of your valid CITI certification. Student certifications are good for the length of their attendance at the institution. Faculty/Staff certifications are renewed every 5 years.
Additional Investigator 3:
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Investigator Position(Required) BSU - Faculty/Staff BSU - Student
Add'l Investigator - CITI Certification(Required) Upload a copy of your valid CITI certification. Student certifications are good for the length of their attendance at the institution. Faculty/Staff certifications are renewed every 5 years.
Advisor/Sponsor for Student Investigator(s):(Required)
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Required for all student research proposals. This includes class projects, student organization projects, and independent projects (i.e. Student Achievement Conference), which require human subject interaction or response, including but not limited to surveys, interviews, experiments, etc.
Advisor/Sponsor Position(Required) BSU - Faculty/Staff
Advisor/Sponsor - CITI Certification(Required) Upload a copy of your valid CITI certification. Student certifications are good for the length of their attendance at the institution. Faculty/Staff certifications are renewed every 5 years.
Advisor/Sponsor - Permission Communication(Required) Upload a communication of permission (i.e. email communication, written notice with signature, etc.) from your Advisor/Sponsor to act as an investigator in an IRB research project.
Requested Review Status(Required) Full Review Expedited Exempt Review
Must include rationale for expedited or exempt reviews. The standard for expedited/exempt status reflects the instruction through CITI and is determined by the IRB, not the investigator.
Rationale for Expedited or Exempt Reviews(Required)
Is the submitted document in draft form yet to be pre-tested?(Required) (If Yes, a final copy of the survey instrument must be resubmitted upon completion.)
Can the title of this study be made public before the completion date?(Required) Are you using BSU students for this study?(Required) If "Yes," notification of the survey should be provided to the VP for Student Life & Success after IRB approval is secured. Questions concerning policies for surveying BSU are directed to the VP for Student Life & Success.
Section I: Subject Recruitment and Requirements* Complete all items on this form and/or on separate sheets of paper attached to this form. *Section includes subjects recruited for pre-testing.
1. What type of human subjects will you require?(Required)
Identify specific characteristics: gender, age, location, affiliation, special characteristics, etc. (i.e. All BSU students, over the age of 18, in online Marketing courses for Fall 2018).
2. Where and how do you propose to recruit participants/subjects?(Required)
Identify all specific recruitment processes: in-person, flyers, emails, phone calls, social media, course postings, etc. Changes to recruitment process will require protocol changes.
3. Notice concerning subjects in Non-BSU institutions(Required) If your study involves subjects in institutions (schools, hospitals, other agencies), institutional consent must be obtained. A single letter of permission from an institutional representative is required (i.e. school superintendent or college VP, corporation supervisor or store manager, etc.). See Sample Permission Letter on IRB site.
Are your participants exclusively from BSU?(Required) PLEASE NOTE: Answer "No" if you are using participants from your own institution (i.e., Bemidji State University . However, notification of the survey should be provided to the VP for Student Life & Success after IRB approval is secured.
Are any of your participants part of another institution?(Required) Examples of other institutions: schools, hospitals, businesses, law enforcement offices, etc.
Attach SIGNED Permission Letters(Required)
If "Yes," attach all complete, signed institutional permission letters. Permission must be granted before submitting IRB proposals for review. Adding non-BSU institutions after IRB approval will require a protocol change.
Section II: Informed Consent Please review the informed consent guidelines and sample on the IRB website.
1. Will your study use minors (subjects under 18 years of age)?(Required) This includes college students who are not yet 18 years of age.
If “No,” how you will ensure that minors will be screened from your study?(Required)
Example 1: The first question in the survey will ask participants to identify their age. If under the age of 18 years, they will be instructed NOT to complete the survey. Example 2: The Qualtrics Survey will ask if the participant is 18 years or older; if they answer "no," the survey will close.
If "Yes," how will parental/guardian consent be obtained for minors and/or participants incapable of giving legal consent?(Required)
Example 1: A separate informed consent sheet will be included for parents/guardians. Example 2: A line for parents/guardians is included in a single informed consent to ensure both the minor and guardian consent.
Submit Parent/Guardian Informed Consent(Required)
If participants are minors, parent/guardian consent must be obtained. Upload the parent/guardian informed consent. If multiple versions of an informed consent will be used, all versions must be submitted.
2. How will consent be obtained from all participants in the study?(Required)
Example 1: A signed informed consent will be collected from each participant. Example 2: Implied consent will be used for an electronic survey ("By continuing to the survey, you understand the information presented and volunteer to participate...").
Submit Participant's Informed Consent(Required) This is consent from the actual study participant, whether or not the participant is a minor (separate from parental/guardian consent). Minors must still be given the option to decline, even with guardian consent. If multiple versions of an informed consent will be used, all versions must be submitted.
3. Is confidentiality assured?(Required) If "Yes," please specify:(Required)
Example 1: Confidentiality is maintained through Qualtrics Survey software and aggregated data process; no names or other identifying items will be released to the investigators or connected to the study instrument. Example 2: Informed consent and raw data will be stored separately in a password protected computer; only the investigators and the advisor/sponsor will have access. Example 3: Signed Informed Consent forms and collected raw data will be stored separately in a locked cabinet/desk; no names or other identifying items will be connected to the study instrument.
If "No," please explain:(Required)
All rationales for not assuring confidentiality must be clearly explained. Notice that "confidentiality is not assured" must be included in the informed consent.
Section III: Benefts and Risks 1. How much time will be required of each participant?(Required)
2. Will subjects be compensated for participation?(Required) Examples: Extra credit for a course, coupons, entrance into a drawing, etc.
If "Yes," please specify:(Required)
Identify a) the type of compensation (extra credit, gift card, etc.) b) the source of compensation (who is guaranteeing/covering the compensation), c) alternative compensation options provided (i.e. if student withdraws from participation, they have a separate extra credit option), and d) how compensation meets confidentiality requirements (participants volunteer for drawing separate from survey submission/results), etc.
3. What benefits do participants obtain by participating?(Required)
Examples: Option to enter into a drawing, assisting a department with improving student experience, no known benefits, etc.
4. What potential risks are participants subjected to by participating? (Select all that apply)(Required) Certain practices are generally to be avoided. If any risks are included in the proposed study, select the appropriate category and justify with attachments. NOTE: Addition of risk to participants increases the likelihood of a full review.
Explanation and rationale for potential risks:(Required)
For each potential risk, explain how the risk applies and give the rationale for incorporating or being unable to avoid the risk to participants. Example: Participants will be asked about their previous experiences planning funerals for family members, which may cause emotional stress or discomfort.
Section IV: Debriefing Please review the debriefing statement guidelines and sample on the IRB website.
1. When/how will participants be provided with feedback about the study?(Required)
2. If deception has been used, how will the subject be informed?(Required)
If no deception was used, please indicate so.
3. Identify what follow-up supports will be available if participants experience adverse effects or undesirable consequences of participation.
NOTE: ONLY BSU students may be referred to the BSU Counseling Center; all others must be referred to an agency outside of BSU. Investigators and sponsors SHOULD NOT be utilized as the contact for undesirable consequences or advserse effects.
Submit Debriefing Statement(Required)
If multiple versions of a debriefing statement will be used, all versions must be submitted. All debriefing statements should include contact information for "unexpected adverse effects." See instructions and sample debriefing statement on IRB website.
Section V: Research Materials All materials, equipment, etc., must be identified and necessary copies submitted before the IRB research proposal may be submitted. Once submitted, please allow at least ten (10) business days for review and/or approval.
1. Identify all questionnaires, inventories, tests, or other materials and instruments that will be used in the study.(Required)
Submit Abstract, Objectives, and Summary of Research Methods(Required)
Submit the following: 1) a 100-150 word abstract, 2) outlined research objectives, and 3) a description or summary of research methods for the proposed study. Do NOT include literature review chapters or paper proposals.
Submit All Questionnaires, Survey Instruments, and Interview Materials(Required)
Attach all versions of the research materials unless the instrument is universally familiar. If multiple versions of materials will be used, all versions must be submitted for review.
2. Identify all electrical, electronic, or mechanical equipment that will be used in the study(Required)
If any equipment has been specially constructed or modified for use in this study, provide images and a description with sufficient detail so that any physical danger may be assessed. If no equipment is necessary, indicate "N/A."
Submit Documentation for Electrical, Electronic, or Mechanical Equipment
If file upload is insufficient, please contact the IRB.
Additional Supplemental Documentation
Please attach any additional supplemental documentation is necessary but not covered by the previous sections.
