UNIVERSITY OF CALIFORNIA, IRVINE
SOCIAL SCIENCE HUMAN SUBJECTS LAB POOL
HS Lab Pool Recruitment Ad Form
NOTE: In order to use the HS Lab Pool for recruitment purposes, you must complete and submit this form to UCI’s
Institutional Review Board (IRB) for review and approval. Submit this form as part of a new IRB application or as a
modification to an existing approved protocol via e-MOD at: http://apps.research.uci.edu/irmod.
When you receive IRB approval of this ad, please provide the approved and stamped copy of it along with your
other approved and stamped documents to the Social Science Lab Administrator at: ssreslab@uci.edu. For
questions or more information about the HS Lab Pool, please visit http://hsl.ss.uci.edu/ or contact the Lab at
ssreslab@uci.edu or (949) 824-1023.
1. Lead Researcher Name and Department:
[type here]
2. Faculty Supervisor/Sponsor Name and Department:
[type here]
3. Study Title (Be sure that the name has not been used before):
[type here]
4. Short Title (Must be fewer than 20 characters):
[type here]
5. Description of Study (i.e., What will participants be asked to do? Describe in fewer than 1,000 characters):
[type here]
6. Selection/Eligibility Criteria (e.g., >18 years old, right-handed, male, female.):
[type here]
7. Exclusion Criteria (e.g., Must not have completed a certain experiment before):
[type here]
8. Time Commitment (Must be in ½ hour increments, e.g., 0.5 hours, 1.0 hours):
[type here]
9. Course Extra Credit Amount (e.g., 1/2 hour – ½ credit; 1 hour = 1 credit):
[type here]
10. Anticipated Benefits (if any):
[type here]
11. Location of Session(s) (Building and Room Number):
[type here]
12. Anticipated Dates and Times for Participation:
[type here]
13. Contact Name, UCI Department, Phone Number and E-mail:
[type here]
Updated: 09/2013
14. Emergency Cancellation Contact (Name, UCI Department, Phone Number and E-mail):
[type here]
Updated: 09/2013