You must obtain written permission to work with any outside group from an agent of that group. A written statement of permission from any external group is required.
This includes any state or local agencies with which you may be working. Please upload the document granting you permission below. PDF is the preferred file type.
Will people in any of the following vulnerable populations be specifically recruited for the study?
Please print and sign the form below. The signed form must be submitted before your proposal may be reviewed by the IRB. Completed forms may be sent via interoffice mail to Dr. Matthew Lundin or scanned and sent to firstname.lastname@example.org.
My signature on this form indicates that the above information is accurate. I understand that it is my responsibility to protect the rights and the welfare of my subjects. I will protect the confidentiality of the information provided by my subjects unless I have obtained their written permission to disclose this information to others.
Faculty advisor: As a faculty advisor I understand that it is my responsibility to insure that I and all students working on this project have received the training needed to conduct the study and to safeguard the wellbeing of the subjects with whom they will interact.
Signature of Principle Investigator _________________________________________________________________________
Signature of Faculty Advisor_______________________________________________________________________________
Please print this page, sign it, send a copy to Dr. Matthew Lundin by interoffice mail or email a scanned copy to email@example.com. Please keep a copy for your records.