I hereby certify that all the information contained herein is accurate. I understand that it is my responsibility to protect the rights and welfare of my subjects.
I agree to conduct this research as presented in this protocol. No changes will be made without approval of the IRB. Any problems, adverse reaction or unforseen conditions encourtered in the use of human subjects will be immediately reported to the chair of the IRB.
Faculty or Staff Advisor: As a faculty or staff advisor, I understand that it is my responsibility to ensure that I and all students working on this project have recieved the training needed to conduct the study and to safeguard the wellbeing of the subjects with whom they interact.
Project title: ___________________________________________
Date: ______________________
Please print this page, sign it, and email a scanned copy to irb@defiance.edu. Please keep a copy for your records.