SOUTHERN ADVENTIST UNIVERSITY — INSTITUTIONAL REVIEW BOARD
FORM D
CERTIFICATION OF READINESS OF STUDENT CLASS PROJECTS
For IRB Use Only:
Tracking Number __________________
Date Submitted __________________
Date Approved ___________________
Title of Class: __________________________________________________________________________
Instructor __________________________________________________________________________
Semester ____________________
Instructor’s Assurance: By submitting this application, I attest that I am aware of the applicable principles, policies, regulations, and laws governing the protection of human subjects in research and that I will ensure that all student projects adhere to these principles. I also certify that all students submitted an application to me before review and that all human subjects’ protections were met. I also certify that I will maintain these forms for no less than three years and I understand that the Chair of the IRB may periodically audit my records.
All forms should be submitted by email to
.
Class Name and Number: _________________________________________________________________
_______________________________________________
Instructor Signature:
Student Name(s)
____________________________
Date
Title of Project
Abstract
Informed Consent Attached Yes _____ Confidentiality Assured
Study is Minimal Risk Yes _____ If no, contact IRB Chair for other application
Permission was obtained from other sites to conduct research (if applicable) Yes ____
Students will complete any Citi trainings related to their studies Yes ____
Student Name(s)
Yes ____
Title of Project
Abstract
Informed Consent Attached
Study is Minimal Risk
Yes _____ Confidentiality Assured
Yes _____ If no, contact IRB Chair for other application
Yes ____
Permission was obtained from other sites to conduct research (if applicable) Yes ____
Students will complete any Citi trainings related to their studies Yes ____

SOUTHERN ADVENTIST UNIVERSITY — INSTITUTIONAL REVIEW BOARD
Student Name(s)
Title of Project
Abstract
Informed Consent Attached Yes _____ Confidentiality Assured
Study is Minimal Risk Yes _____ If no, contact IRB Chair for other application
Permission was obtained from other sites to conduct research (if applicable) Yes ____
Students will complete any Citi trainings related to their studies Yes ____
Yes ____
Student Name(s)
Title of Project
Abstract
Informed Consent Attached
Study is Minimal Risk
Yes _____ Confidentiality Assured
Yes _____ If no, contact IRB Chair for other application
Permission was obtained from other sites to conduct research (if applicable) Yes ____
Students will complete any Citi trainings related to their studies Yes ____
Yes ____
Student Name(s)
Title of Project
Abstract
Informed Consent Attached Yes _____ Confidentiality Assured
Study is Minimal Risk Yes _____ If no, contact IRB Chair for other application
Permission was obtained from other sites to conduct research (if applicable) Yes ____
Yes ____
Students will complete any Citi trainings related to their studies Yes ____
Student Name(s)
Title of Project
Abstract
Informed Consent Attached
Study is Minimal Risk
Yes _____ Confidentiality Assured
Yes _____ If no, contact IRB Chair for other application
Permission was obtained from other sites to conduct research (if applicable) Yes ____
Students will complete any Citi trainings related to their studies Yes ____
Yes ____
Student Name(s)
Title of Project
Abstract
Informed Consent Attached Yes _____ Confidentiality Assured
Study is Minimal Risk Yes _____ If no, contact IRB Chair for other application
Permission was obtained from other sites to conduct research (if applicable) Yes ____
Students will complete any Citi trainings related to their studies Yes ____
Student Name(s)
Title of Project
Yes ____
Abstract
Informed Consent Attached
Study is Minimal Risk
Yes _____ Confidentiality Assured
Yes _____ If no, contact IRB Chair for other application
Yes ____

SOUTHERN ADVENTIST UNIVERSITY — INSTITUTIONAL REVIEW BOARD
Permission was obtained from other sites to conduct research (if applicable) Yes ____
Students will complete any Citi trainings related to their studies Yes ____
Student Name(s)
Title of Project
Abstract
Informed Consent Attached Yes _____ Confidentiality Assured
Study is Minimal Risk Yes _____ If no, contact IRB Chair for other application
Permission was obtained from other sites to conduct research (if applicable) Yes ____
Students will complete any Citi trainings related to their studies Yes ____
Student Name(s)
Yes ____
Title of Project
Abstract
Informed Consent Attached
Study is Minimal Risk
Yes _____ Confidentiality Assured
Yes _____ If no, contact IRB Chair for other application
Yes ____
Permission was obtained from other sites to conduct research (if applicable) Yes ____
Students will complete any Citi trainings related to their studies Yes ____
Student Name(s)
Title of Project
Abstract
Informed Consent Attached Yes _____ Confidentiality Assured
Study is Minimal Risk Yes _____ If no, contact IRB Chair for other application
Permission was obtained from other sites to conduct research (if applicable) Yes ____
Students will complete any Citi trainings related to their studies Yes ____
Yes ____
Student Name(s)
Title of Project
Abstract
Informed Consent Attached Yes _____ Confidentiality Assured
Study is Minimal Risk Yes _____ If no, contact IRB Chair for other application
Permission was obtained from other sites to conduct research (if applicable) Yes ____
Students will complete any Citi trainings related to their studies Yes ____
Yes ____
Student Name(s)
Title of Project
Abstract
Informed Consent Attached
Study is Minimal Risk
Yes _____ Confidentiality Assured
Yes _____ If no, contact IRB Chair for other application
Permission was obtained from other sites to conduct research (if applicable) Yes ____
Students will complete any Citi trainings related to their studies Yes ____
Yes ____