WNMU-IRB-application

Institutional Review Board (IRB) Application for Review
Instructions: In preparing your proposal, please address and organize your materials as shown in example shadow text within the requested text boxes. You may save your application as you go, so that you can come back and work on it at a later time. It is suggested you cut and paste from a working document, into the entry fields for each section. Please observe the word limits if possible. Otherwise attach extra documentation where indicated. Type N/A in any fields that do not apply. Do not leave fields blank.

The IRB Coordinator acts as the initial contact for the proposal. Please direct your questions to wnmu-irb@wnmu.edu. Thank you.
I. Primary Researcher Information:

Tell us a bit about yourself
Full Name*

First NameLast Name
WNMU Identification Number (W00)*
Title or Position*
Phone Number*

Area CodePhone Number
E-mail*
Please indicate correct E-mail as your confirmation and future communications will be sent to this address.
Alternate E-mail
Today (internal use only)

MonthDayYear
Faculty Mentor Information

If you are a student, your faculty mentor needs to have approved you submitting this IRB application and is committed to send in a letter of support on your behalf when contacted. If you do not have the permission to do this yet, please do not continue.
Responsible Faculty Mentor (if applicant is a student; otherwise, enter "N/A")*

First NameLast Name
Mentor's E-mail (leave blank if not applicable)
Mentor Approval: If you are a student, has your faculty mentor reviewed this application? *

YesNoNot applicable
You indicated that you have your mentor's approval to submit an IRB application. Please remember to provide your mentor's e-mail address if you haven't done so. We need a letter of support from your mentor in order to start the evaluation process. Thank you.
Sorry! You may not continue if your application has not been reviewed by your faculty mentor or if your faculty mentor is not committed to submit a letter of support on your behalf. Please have your faculty mentor review your proposal first and come back to submit your application soon! Thank you.
II. Research Project

Tell us a bit about your project.
Title of Research Project*
Intended time period of this research*
A. Research Assistant Information: Names of any others who make contact with human participants. Indicate type of assistant and how and by whom they will be trained and supervised.

0/50
B. Proof of training: The NIH offers a free online training. At the end, you will be provided with a certificate. Please save and paste that image for each researcher into one file. The certificates assure the IRB that all researchers have completed a certification in Protecting Human Research Participants - Please upload the file containing all certificate images for all persons who will be involved in data collection, analysis and reporting.*

Upload up to four certificates

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C. Project status: 1) Indicate project status: for example, grant supported, independent research, master’s thesis, capstone project, and so on. If you area student researcher, please describe how this project connects to or serves your studies and progress toward graduation. 2) Are you receiving any funding for this research? If so, please explain and provide details. 3) Will multiple institutions be used to collect data? If so, approval from those other sites may be required before the IRB will consider your proposal. Feel free to consult with the IRB Coordinator about this. (Address all three of these points)*

0/200
D. Purpose and objective of the research: State the research problem and aims of the research. Include background literature that helps to place this research in the context of the field. Describe any benefits to participants or to society, including compensation. Also include some information about your intention for public dissemination of your findings.*

0/1000
III. Methods and Procedures

Please note that responses here should relate to your purpose and objectives (if not clear, explain how they relate).
E. Participants: Describe the subject population, recruitment activities, and criteria for selection or exclusion. Justify the use of any special populations (e.g., children, prisoners, adults who do not have legal autonomy, participants who might have issues that challenge or impair their ability to give consent, pregnant women).*

0/750
F. Materials: Summarize instruments (questionnaires, interviews, observations, tests, etc.) and other methods of data recording (notes, audiotapes, videotapes, etc.). All instruments, experimental stimuli and other materials must be submitted in their full and final versions for review. Clear indication of the recording, scoring and intended analysis of data must be described.*

0/750
G. Procedures: Provide a concise and complete description of your procedures, taking care to emphasize any and all potential risks and potentially sensitive issues. Address risk-benefit issues; i.e., do the benefits justify the risks? Describe all activities involving the human subject, including duration and frequency of each activity. Consent and debriefing information is requested below.*

0/750
H. Consent/Assent and Debriefing:
Consider the following: What information is necessary to ensure that consent is adequately “informed”? If individuals with impaired abilities to give consent, such as children, will be used, what manner of assent is appropriate? Note that the term “children” includes anyone under the age of 18 and that Western New Mexico University enrolls a substantial number of students under the age of 18 years as dual enrolled high school students who require parental consent in order to participate in any research study. All proposals that involve students from WNMU must address the following:
- how minor students will be identified,
- how written parental consent will be obtained,
- how such students will be excluded if consent cannot be obtained or is declined.
In addition, the intended use(s) of the results of the study must include description of how the identities of the students will be protected and any identifying information eliminated if used in publication. Measures to prevent unintended uses of the data collected in the implementation of the study. (Including digital recordings of images and sounds as well as written notes.)
Attach your consent and or assent form. Note: the form must contain the following statement: “If you would like to discuss or comment on any aspect of this project, please contact the WNMU Institutional Review Board at wnmu-irb@wnmu.edu” *

Upload up to four files

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H. Plan for Debriefing*

0/250
I. Data Use and Storage: Describe any procedure or measure to protect the privacy of subjects and to maintain the confidentiality of the data. Describe data handling and storage to insure appropriate use and protection of human participants.*

0/250
J. Changes: Indicate that you agree to promptly bring to the attention of the IRB any changes in methods or procedures from those described above or any unexpected consequences adversely affecting the subjects.*

0/250
K. Other Supporting Documents: Please attach any other documents referenced above, such as surveys, assessment tools, debrief or other scripts, etc.

Upload up to four files

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IV. Certification Statement
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. Additionally, you are agreeing to:

1. promptly bring to the attention of the IRB any changes in methods or procedures from those described above or any unexpected consequences adversely affecting the subjects.

2. review the protocol and application materials and certify that the proposed study involves no known risks other than those specified. Furthermore, I certify that the protocol procedures conform to the norms, ethical standards, and accepted methods within my discipline, to the best of my knowledge

When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature:*
Coordinator Login (internal use only)
V. IRB Internal Use
IRB Application #
Application Status
Last Updated On
This form is largely a modified version of the current UNM form of which WNMU has gained permission to use.
Should be Empty:

Institutional Review Board (IRB) Application for Review

I. Primary Researcher Information:

II. Research Project

III. Methods and Procedures

IV. Certification Statement

V. IRB Internal Use