Request for Class Project Waiver of IRB Application
Student Section:
Student(s) Name
Department
Email
Phone
Course Number and Title
Semester/Year
/
Describe class assignment.
Describe the risks associated with this project and how risks will be managed. Describe procedures for maintaining
confidentiality and steps for monitoring the project or activity.
Waiver Requirement Checklist:
Provide assurance by checking the box below for each of the following:
The project/activity is being conducted solely for the purpose of receiving a grade.
There will be no publication and no presentation outside of the University without prior IRB approval.
No use of minors or vulnerable populations (including but not limited to prisoners, pregnant women, non-Englishspeaking persons, persons lacking capacity to give informed consent).
Risk is not more than “minimal.”
“Minimal risk” is when “the probability and magnitude of harm or discomfort in the research are not greater in and of
themselves than those ordinarily encountered in daily life or during the performance of routine physical or
psychological examinations or tests.”
No use of deception.
No audio or videotaping.
I attest that the above information is accurate and represents the true nature of my class project/activity.
Student(s) Signature
Student(s) Name Printed
The Utah Valley University Institutional Review Board
CITI Number (required)
Page 1 of 2
Date
12/17/12 revised
Request for Class Project Waiver of IRB Application
Instructor Section:
Instructor Name & Title
Email
Phone
As the Instructor, I accept primary responsibility for ensuring the rights and welfare of the human subjects and to:
 Train students in the proper conduct of research and the protection of human subjects;
 Review student’s Class Project Waiver of IRB Application and submit waiver to the IRB for determination if
each project qualifies for a waiver, and require a standard IRB application if not;
 Ensure that students get written or verbal informed consent from subjects;
 Review all methods and instruments used in each project;
 Document that students receive permission to conduct the project/activity at institutions or organizations
other than Utah Valley University;
 Monitor the research and inform the IRB immediately of any significant problems that arise.
If a class project or activity does not fall within the above parameters as found in the Waiver Requirement Checklist
above, the Instructor is responsible to see that the student(s) complete an Application for Approval for the Use of
Human Subjects in Research that will be reviewed through the normal processes of the IRB.
Class projects that involve human subject research designed to develop or contribute to generalizable knowledge are
considered research under the purview of the IRB.
Instructor Signature
CITI Number (required)
Date
Send form with attachments to IRB, BA 203 or Inter Campus to MS 272.
Approved by:
IRB Chair Signature
The Utah Valley University Institutional Review Board
Date
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12/17/12 revised