Institutional Review Board Forms

 Important Notes:

No research or subject contact can take place until you have received a formal IRB approval letter.

Preferred submission method: Single pdf file emailed to irb@georgiasouthern.edu

All applications for full board review must be complete and in the Office of Research Integrity by the deadlines listed here.

Expedited applications are reviewed on a continuing basis.

Use the following forms for all IRB submissions requiring full or expedited review.

Form Name Additional Form Information
Compliance Cover Page Complete for all expedited and full board reviews.
REQUIRED FOR ALL EXPEDITED AND FULL BOARD
Proposal Narrative Note: Do not include dissertation or thesis chapters. Information required for review must be condensed into the narrative format. REQUIRED FOR ALL EXPEDITED AND FULL BOARD
Certification of Investigator Responsibilities (CIR) Signature required.
REQUIRED FOR ALL EXPEDITED AND FULL BOARD
CITI Human Subjects Training CITI Program training provides social/behavioral content training. Online certificate will be provided to you once the course is completed. Attach certificate or transcript to each protocol submitted. Certificates are not maintained by the IRB.  Training certificates from previous submissions are not readily available.  Click here for instructions. REQUIRED EACH TIME YOU APPLY.
Informed Consent Sample This is a sample of an informed consent document provided on an electronic version of GS letterhead.  Any information in the sample should be edited as appropriate for the population you are using and the type of research you are conducting. Click here for further information on HIPAA consent criteria.
Informed Consent Checklist Tool for the construction of an Informed Consent document.
Minor’s Assent Form Sample This is a sample of a minor assent document provided on an electronic version of GS letterhead.  Any information in the sample should be edited as appropriate for the population you are using and the type of research you are conducting.  Your assent should be on a reading level appropriate for the participant’s age.
Parental Informed Consent Sample This is a sample of a parental consent document provided on an electronic version of GS letterhead.  Any information in the sample should be edited as appropriate for the population you are using and the type of research you are conducting.
Instrument Please include a copy of all instruments to be used in the research (surveys, questions, etc.)
Recruitment Materials Please include a copy of all materials to be used for recruitment (flyers, emails, etc.)
Georgia Southern Survey Policy Georgia Southern’s Policy on the distribution of surveys to faculty, staff, and students.
Sample Letter of Cooperation (LOC) If subjects are students or employees of another institution, include a written letter of cooperation from the subjects. This may be a letter or email from the institutional official’s professional address with the institutional officer and title identified in the email body. All letters of cooperation must clearly identify the investigator and project by title. (See the FAQ for additional information.)  Note: If using education data obtained from school records you must include documentation of parental permission for the release of such data under the Family Educational Privacy Act (FERPA). This may be a copy of the release form, informed consent, or an assurance from the institutional official that such permission has been obtained prior to data release.
Form Name Additional Form Information
Compliance Cover Page Complete for all IRB submissions requiring exempt review.  REQUIRED FOR ALL EXEMPT APPLICATIONS
CITI Human Subjects Training CITI Program training provides social/behavioral content training. Online certificate will be provided to you once the course is completed. Attach certificate or transcript to each protocol submitted. Certificates are not maintained by the IRB.  Training certificates from previous submissions are not readily available.  Click here for instructions. REQUIRED EACH TIME YOU APPLY.
One of the following REQUIRED FOR ALL EXEMPT APPLICATIONS:
Category B1 Exempt Form Use for research conducted in established or commonly accepted educational settings, involving normal educational practices. Click here and then the Exempt tab for further details.
Category B2/B3 Exempt Form Use for research involving the use of educational tests (cognitive, diagnostic, aptitude, achievement), survey procedures, interview procedures or observation of public behavior. EXCEPTIONS APPLY. Click here and then the Exempt tab for further details.
Category B4 Exempt Form Use for research using preexisting data.  EXCEPTIONS APPLY. Click here and then the Exempt tab for further details.
Category B6 Exempt Form Use for taste and food-quality evaluation and consumer acceptance studies . Click here and then the Exempt tab for further details.
If your project accesses subjects or data from another school, institution or business add:
Sample Letter of Cooperation (LOC) Note: (See FAQ for additional information) If using education data obtained from school records you must include documentation of parental permission for the release of such data under the Family Educational Privacy Act (FERPA). This may be a copy of the release form, your informed consent or an assurance from the institutional official that such permission has been obtained prior to data release.
Form Name Additional Form Information
Compliance Cover Page Complete for research projects where all students are performing the same research – no publication or presentation of results REQUIRED FOR ALL
Research Methods Projects IRB Application The instructor completes this form
REQUIRED FOR ALL
Tools  Description
CITI Human Subjects Training Instructor submits theirs with application. Instructor maintains student training certificates.  Click here for instructions.
Research Methods Project Informed Consent Model Informed Consent Template
Student Approval for Research Methods Projects Form Student completes this form. Instructor maintains the form
Research Methods Project Guidelines Determining what qualifies for a research project exemption
Form Name Additional Form Information
Renewal/Project Extension Form Use to renew or extend approved IRB protocols
Termination Form Use to terminate an IRB protocol at the end of every research project
Adverse Events Reporting Form Use to report adverse events during the course of a research project
Amendment Form Use to request an amendment to an approved IRB protocol
International Supplement Use where project will occurs outside the U. S. or use international subjects
PHI Authorization Language Additional information required in an informed consent for use of PHI
PHI Authorization Waiver Form Use for PHI collection where patient authorization (consent) can not be accessed without compromising the research
HIPAA De-Identification Certification Form Use to certify receipt of data in a de-identified format for HIPAA purposes
Name Additional Information
Transcriptionist/Translator/Statistician Agreement  Confidentiality Agreement for Use with work for hire translation/transcription/statistics
Student Photo Release  Georgia Southern University license to use student photo for commercial and educational purposes
License to Use Student Work  Georgia Southern University license to use student work for commercial and educational purposes
FileLocker A secure way to transfer research data
NIH Certificate of Confidentiality Template Used where research data is collected about illegal behavior to limit law enforcement ability to access
Georgia Southern University Researcher Participation Standard Release A waiver of liability for students participating in research projects as student researchers.
Research Aide Non-Disclosure Use where 3rd party is used to distribute research materials but is not party to research or GS student
Human Subjects Incentive Policy Policy on the use of human subjects incentives.  (Use form below to record distribution/for reimbursement)
Human Subjects Incentive Disbursement and Reconciliation Form Use to record distribution of research incentives. Tab 2 records incentives outstanding over 30 days.
Individual Investigator Agreement Template Used were GS faculty collaborate with investigators who are not associated with federally assured institution.
Reciprocal Policy/Form Use where GS faculty is not the PI and another IRB will hold primary approval
Survey Distribution Policy Georgia Southern policy on requests from on-campus and off-campus entities for the distribution of surveys to various populations

Last updated: 9/5/2017

Office of Research Integrity • PO Box 8005, Statesboro, GA 30460 • (912) 478-5465 • irb@georgiasouthern.edu