CHECKLIST FOR PROPOSAL SUBMISSIONS TO THE IRB

To avoid delays in the approval of your application:

1. Be sure to answer all questions fully in the application.

AND

2. Review your application to ensure it includes these checklist items. Check-off the items in this list or mark N/A if not applicable.

This Form Must Be Included with Your Application

Consent Form – Includes:

____ Name(s) of Researcher(s)

____ Advisor’s name, title, and department

____ Reference to your affiliation with Clark University

____ Brief description of the purpose of the study and the tasks involved

____ Approximate duration of participation

____ Any foreseeable risks/discomforts and/or expected benefits to participant or others

____ Statement that participation is voluntary and may be withdrawn without penalty at any time

____ Statement that participants may choose to not answer any question that they wish not to answer

____ Procedures for ensuring confidentiality (explanation of coding, storage, and disposal of data)

_____ Data will not contain any names, only code numbers

_____ Data and identifying information, such as consent forms, will be stored separately from each other

_____ Data will be stored in a locked or password protected storage on Clark campus accessible only to
researchers. Undergraduates must store data with faculty advisors.

_____ Final disposal of any audio or video tapes is described

____ Where potentially necessary, a list of counseling/support resource(s) for participants

____ Contact information for the researchers

____ Statement of Assent for participants under the age of 14 (consent form must be addressed to parents/guardians in this circumstance)

____ The statement: “This study has been approved by the Clark Committee for the Rights of Human Participants in Research and Training Programs (IRB). Any questions about human rights issues should be directed to the IRB Chair, Dr. Linda M. Kennedy (508) 793-7476.”

Attachments – Include the following where relevant to your study:

_____ Recruiting Script(s) (oral script, telephone script, email script, flyer, etc.) which includes the following information:

Researcher’s name
Advisor’s name and department
Reference to affiliation with Clark University
Brief description of the task(s)
Approximate duration of participation
Statement that participation is voluntary and may be withdrawn at any time without penalty
Contact information of researchers
A statement that if participants are recruited in a class, their participation or non-participation will have no effect on their standing in class

_____ Questionnaires, Surveys (hard copy for on-line surveys) and/or Interview Protocols

_____ Written permissions from schools, agencies, organizations, etc. at which research will be conducted

_____ Text of debriefing statement when deception is involved in the study

_____ For research being conducted in a foreign country by a student, provide a letter from a local sponsoring institution certifying they have reviewed the research from the perspective of safety for the student and they find it reasonable to proceed