FOR OFFICE USE ONLY: CSRC Protocol # _____________ Routed: _______________

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FOR OFFICE USE ONLY: CSRC Protocol # _____________
Application Received: ______________
Routed: _______________
Training Complete: ____________________
Confidential / Sensitive Research Committee
Application for Approval Form
ADMINISTRATIVE INFORMATION:

Title of Project: (if applicable, use the exact title listed in the grant/contract application)

Type of Application:
New, Addendum/Modification,
Other (explain)

Funding Source: (identify all source(s) of funding for the project)

Principal Investigator: (must be a KSU faculty member)
Name:
Department:
Campus Address:
E-mail
Degree/Title:
Campus Phone:
Fax #:

Contact Name/Email/Phone for
Questions/Problems/Emergencies:

Does this project involve any collaborators not part of the faculty/staff at KSU?
No
Yes

Project Classification (Is this project part of one of the following?):
Thesis
Dissertation
Class Project
Faculty Research
Other:
If you have questions, please call the University Research Compliance Office (URCO) at 532-3224, or [email protected]
Version #2; 06/23/05
Confidential / Sensitive Research Committee Application
The KSU University Handbook) contains a policy for the conduct of Classified Research (Sections G51-53). Broadly defined,
the policy addresses “research about which any of the following aspects are kept secret for an indefinite period of time with
control of their release or publication exercised by an agency other than the university:
1.
2.
3.
4.
5.
6.
Purpose of the research
Names of the investigators
Amount and source of the funds
University facilities used
Research procedures
Results of the research
The Confidential / Sensitive Research Committee (CSRC) is a Presidential Committee chartered to protect the interests of
university faculty, unclassified professionals, students, and other applicable staff during the conduct of research activities
involving information that is deemed to be sensitive, confidential, or classified in nature. The committee will verify
that the proposed activity involving confidential, sensitive, or classified research does not hinder
any participating student from completing his/her degree(s) and publishing the student’s required
work for the degree(s) and does not hinder any participating faculty member from gaining tenure.
The CSRC review is not intended to compromise the confidential or sensitive information itself in any way. Completion of
this application and formal approval by the CRC is necessary prior to the initiation of the project at KSU. Additionally,
approval from all other applicable compliance committees such as the IRB, IACUC, and IBC must be received prior to
initiation of the proposed activity.
Principal Investigator:
Activity Title:
Nature of the Sensitivity: (please indicate the nature of the confidential / sensitive information).
DoD Classified
Business Sensitive
Proprietary Information
Intellectual Property
Other: (if other, please explain)
Non-Technical Synopsis: (Please provide a brief narrative description of the proposed activity in lay or general terms
that does not compromise the information-sensitive nature of the activity).
Personnel: (Please provided the following information on all personnel involved in the proposed activity).
Name
Department
Title
Role in the Activity
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Safeguards of Personnel: (Please provide a through description and plan for assessing and to protecting the
professional and career interests of KSU personnel involved in this activity, to include tenure, degree, and publishing
considerations).
Projected Duration: (Please provide an estimate of the duration of the proposed activity).
Security: (Please provide information on how you intend to provide adequate security (physical, electronic, etc.) for the
sensitive information involved with your proposed activity, if appropriate. Also reference any security regulations, guidelines
or policies that are applicable to your proposed activity.)
1
2
Security Plan:
Security Regulations/Documents:
Export Control Laws: (any funded project that accepts secrecy provisions of any type, such as those being reviewed by
the CSRC, are subject to Export Administration Regulations {EAR} and / or International Traffic in Arms Regulations
{ITAR}. The P.I is personally responsible for compliance with the ITAR and EAR regulations, with possible fines up to
$1million dollars and 10 years in prison for noncompliance. Information regarding export regulations are linked on the CSRC
webpage at http://www.k-state.edu/research/comply/csrc/index.html.
Does your proposed activity fall under the EAR and ITAR regulations?
Do you have an Export License?
Are you in compliance with ITAR and EAR regulations?
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Investigator Assurance for Confidential / Sensitive Research Committee
(Print this page separately because it requires a signature by the PI.)
P.I. Name:
Title of Project:
ASSURANCES: As the Principal Investigator on this protocol, I provide assurances for the following:
A.
Research Involving Confidential / Sensitive Information: I assure that this project will be performed
in the manner described in this proposal, and in accordance with all applicable laws, regulations, and
guidelines. Any proposed deviation or modification from the procedures detailed herein must be
submitted to the URCO, and be approved by the CSRC prior to implementation.
B.
Compliance Committee Approval: I assure that I will secure approval as appropriate for all activities
that fall within the regulatory purview of other university compliance committees, IBC, IACUC, IRB,
EHSC, etc., prior to initiation of the proposed activity.
C.
Extramural Funding: If funded by an extramural source, I assure that this application accurately
reflects, as appropriate, the activity as described in the grant/contract proposal to the funding agency.
I also assure that I will notify the CSRC / URCO, if there are proposed modifications or changes
needed for the activity after the initial submission to the funding agency and approval by the CSRC.
D.
Personnel Protection: I assure that I will adhere to the provisions of the approved CSRC protocol for
protecting the interests and welfare of all KSU personnel involved with this project or activity.
E.
Personnel Changes: I assure that I will notify the CSRC / URCO with appropriate safeguard
information when personnel changes occur on this activity,
F.
Security: If there are security laws, regulations, or guidelines applicable to this proposed activity, I
assure that my research team and I will comply with the provisions as appropriate.
(Principal Investigator Signature)
(Date)
Version #2; 06/23/05
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