Human Subjects Review Proposal Application
Reapplication:
Mark an “X” in the appropriate category:
New Application:
Revision: (Highlight All Changes)
Primary Researcher Information (Mark an “X” in One)
Name:
Last
Institutional Affiliation:
Address:
Director of Institutional Research
Gordon College
419 College Dr.
Barnesville, GA 30204
678-359-5108
Faculty
First
Division / Department:
Admin/Staff
M.I.
Student
Street
Address:
City
Primary Phone:
State
E-mail (required):
Faculty Sponsor / Co-Researcher
(Mark an “X” in One)
Faculty
Name:
First
Division / Department:
Address:
Last
Institutional Affiliation:
Street
Zip Code
Admin/Staff
M.I.
Student
Address:
City
Primary Phone:
State
E-mail (required):
Zip Code
Signature of Primary Researcher Date
Your signature indicates that you have read the human subjects information posted on the Gordon College
Human Subjects Review Committee web site and accept responsibility for the research described in this proposal.

Human Subjects Review Proposal Application (continued)
Research Title:
Date you would like to commence research:
Date you expect to complete data collection:
Date NIH Online Training completed (attach copy of completion certificate):
Please provide a typed, detailed answer to each of the following:
1. Please provide a brief problem abstract that describes your study, why it is important to your discipline, and what you expect to learn.
2. Discuss your participant parameters, include the intended number of participants and their demographic descriptions. Discuss why these parameters are important to your study.
3. Discuss any incentives, follow-up, or compensation to be used with individual participants, including payment, gifts, etc.
4. Describe your research procedures. This includes participant activities and time commitment, settings and times for data collection, and materials involved (such as questionnaires, tests, etc.)
5. Discuss any perceived risks to participants during the course of the study or in the future.
6. Discuss the benefits to the participants and to humanity that may be gained from this study.
7. Discuss any use of deception in your data collection procedures.
8. Discuss your process for obtaining informed consent from research participants or, if minors, their parent(s) or guardian(s). Be certain to include discussions of time, location, and privacy.
9. If minors are involved, discuss your procedure for obtaining consent to participate from the minor, in addition to your procedure for obtaining consent to participate from their parent(s) or guardian(s).
10. Participants must be assured their data is either anonymous or will remain confidential. If the data will be confidential, you must inform research participants that you may not be able to guarantee confidentiality if disclosure should be required by law. Some illegal activities must be reported (e.g. child abuse). When anonymous questionnaires are used by written informed consent is necessary, consent forms may be signed and returned separately. This procedure avoids any possibility of linking names to the data. Does the data to be collected relate to illegal activities? If yes, please explain.
PLEASE NOTE: Applicants may be required to provide a presentation in person to the Human Subjects
Review Committee in order to complete the application process.