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STETSON UNIVERSITY
IRBHP PROPOSAL FORM
Instructions
Please scroll through the entire form prior to reading these instructions.
Doing so will make the instructions clearer.

The different sections of the form are in Microsoft Word tables. Thus, as you
type in information don’t be surprised if the row and table expand. (So, don’t
be concerned if table rows break across pages.)
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Please complete only those sections that are useful in presenting your
proposal and supporting information. For example, if there is only one
Principle Investigator you only need to enter information for that person
(and, thus, leave the second section blank).
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In some sections you will be asked to enter information into a text field. This
kind of entry looks like this:
. To enter information, simply place your
cursor on the box and click. The box will change color when you do so. You
then may start typing.
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You probably will need to submit supplemental materials such as a survey or
a letter of permission/cooperation. You also have to submit an Informed
Consent Form. Please copy and paste any of these materials into this file, if
possible.
IRBHP Proposal Form (Rev. 2/17/14)
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STETSON UNIVERSITY
IRBHP PROPOSAL FORM
Project Title:
Date (mm/dd/yy) Research is to begin:
Date (mm/dd/yy) Research is to conclude (anticipated):
Principal Investigator(s)
Name (1):
Dept.:
Ext:
Email:
Name (2):
Dept.:
Ext:
Email:
Faculty Adviser (required for all student research)
Advisor Name:
Dept.:
Ext:
Email:
Acknowledgement of Responsibilities
As the typed signature below testifies, the principal investigator pledges to conform to
the following: As one engaged in investigation utilizing human subjects, I acknowledge
the rights and welfare of the participants involved. I acknowledge my responsibility to
secure the informed consent of the participants by explaining the procedures and by
describing the risks as weighed against the potential benefits of the investigation. I
assure the IRBHP that all procedures performed under the project will be conducted in
accordance with those Federal regulations and College policies that govern research
involving human subjects. Any deviation from the project (e.g., change in
principal investigator, research methodology, etc.) will be submitted to the
IRBHP via email for its approval prior to implementation. I agree to report all
adverse events IMMEDIATELY to the IRBHP.
PRINCIPLE INVESTIGATOR:
DATE:
The Faculty Adviser's typed signature on the Research Proposal
confirms that he or she supervised the composition of the proposal and
approves of the research proposal as submitted.
FACULTY ADVISOR:
IRBHP Proposal Form (Rev. 2/17/14)
DATE:
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SUMMARY: Briefly summarize in one paragraph the purpose of the
research and planned use of human participants in terms
understandable to a layperson.
IRBHP Proposal Form (Rev. 2/17/14)
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LITERATURE REVIEW: Provide a brief 1-2 page review of the most
current research that covers the background and rationale for your
research. This review should convey the importance of the topic,
summarize the current state of the literature, and indicate what topics
warrant further study. Provide in-text citations (and full citations in the
references section provided later in this form). Single space within
paragraphs and double space between paragraphs.
IRBHP Proposal Form (Rev. 2/17/14)
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PURPOSE AND HYPOTHESES: State in one sentence the purpose of
your research. State any hypothesis you will be testing in the null form.
IRBHP Proposal Form (Rev. 2/17/14)
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METHODOLOGY
Participants: If you are only observing public behavior, skip to
question d in this section.
a) How many participants will be involved in the research?
(Enter text here):
b) List specific eligibility requirements for participants (or describe
screening procedures), including those criteria that would
exclude otherwise acceptable participants. For example, if your
study uses only male or female participants, explain why. If
using data from a secondary de-identified source only, skip
to question e in this section.
(Enter text here):
c) How will participants be recruited? (In your Appendices, attach
any flyers, letters, announcements, etc. that will be used to
recruit participants.) Also, describe your sampling method
(convenience, simple random, stratified random, etc.)
(Enter text here):
d) Is there any formal relationship between researcher and
participant (e.g. teacher/student, principal/teacher,
employer/employee, etc.) that might lead to the perception of
coercion? If so, identify options to participation.
(Enter text here):
IRBHP Proposal Form (Rev. 2/17/14)
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e) Does your study focus specifically on any of the following
vulnerable participant populations? (If so, please type an “x” in
the appropriate box(es)):
minors (under age 18 – specify age range)
prisoners
pregnant women & fetuses
persons with physical disabilities
persons with mental disabilities
economically or educationally disadvantaged
other, please specify:
If any of the above are to be participants in this research project,
state the necessity for doing so. Please indicate the approximate
age range of the minors to be involved. (Participants under age 18
require the participant’s assent and written consent from a parent
or legal guardian.)
(Enter text here):
IRBHP Proposal Form (Rev. 2/17/14)
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Research Methods
Please indicate your research methods (please place an “x” in all that
apply):
Interview, Focus Group or Non-Anonymous Questionnaire
Anonymous Questionnaire
Observation of public behavior
Experimental design (if stating causal hypotheses):
(If you are using an experimental design, please describe the
design you will be using. Consult the discussion here to help you
appropriately describe your design.)
Analysis of de-identified data collected elsewhere:
Where did this data come from originally?
Did this original research get IRB approval?
Other (specify):
Please describe the procedure to be followed in your research (e.g.
what participants will do). Describe step-by-step the nature of the
interaction between the researcher and the participants. Include, if
appropriate, a description of the ways in which different subjects or
groups of participants will receive different treatment.
(Enter text here):
IRBHP Proposal Form (Rev. 2/17/14)
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How many times will you meet/interact with the participants? If you
are only observing public behavior, skip to question d in this
section.
(Enter text here):
a) How much total time will be required of each participant?
(Enter text here):
b) Where are the performance sites for this research (i.e., where it
will it take place)?
(Enter text here):
c) If you are using surveys, attach a copy of the survey instrument
to this proposal. If you are conducting individual interviews or
focus groups, including ethnographies and oral histories, attach,
or list here, a list of interview questions. If the interview format
is not yet specified or you are conducting unstructured
interviews, please attach, or list here, a list of specific topics to
be discussed.
(Enter text here):
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d) If you are using a copyrighted questionnaire, psychological test,
or scale, please indicate how you obtained permission and
attach in the appendices a copy of the permission.
(Enter text here):
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Analysis
a) Statistical Analysis: If you are using a form of parametric or
nonparametric statistical analysis, please identify the name of
the technique(s) (e.g., t-test, correlation, etc.) and the steps
you will follow to conduct the analysis. Please indicate the
technique and steps for each hypothesis you plan to test.
(Enter text here):
b) Qualitative Analysis: If you are using a form of qualitative
analysis please indicate the type of analysis (e.g., grounded
theory, ethnographic, etc.), your approach, and any coding
procedures you plan to use.
(Enter text here):
REFERENCES
Please include references cited in your review of the literature and any
citations in your discussions.
(Start references here)
APPENDIX
Please include in your appendix any of the following items (in the order
listed here) that are part of your research:
IRBHP Proposal Form (Rev. 2/17/14)
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Copyrighted surveys, psychological tests, and scales.
Written permission to use the copyrighted materials.
Surveys, psychological tests and scales that are not copyrighted
or that you have designed yourself.
Any qualitative data collection instruments (e.g., structured
interview questions).
Letters of cooperation for any organizations (except Stetson) you
are working with to collect your data (e.g., a school, a company,
etc.). Letters should be signed by a person with authority to
approve you data collection at the site and who will serve as a
contact person.
Any other documents that will help the Stetson University IRBHP determine the value of your research.
 Your INFORMED CONSENT FORM!
Please remember to copy these materials within this document,
if possible.
IRBHP Proposal Form (Rev. 2/17/14)