UWG Institutional Review Board (IRB)
Classroom Research Form
Complete this form and submit it to irb@westga.edu for a determination of exemption of this
project from IRB oversight. Once reviewed, decisions will be emailed to the faculty member.
1. Instructor: Click here to enter text.
2. Class: Click here to enter text.
3. Number of Students: Click here to enter text.
4. Semester/Year: Click here to enter text.
5. Description of the project assignment:
Click here to enter text.
6. As course instructor, my submission of this form to the UWG IRB certifies that:
a) I have completed UWG’s required web-based training course
(http://www.citiprogram.org/) on research involving human subjects (or training accepted
by UWG’s IRB for substitution).
b) I have primary responsibility for ensuring that the students participating in the above
assignment do not violate the rights and welfare of human subjects.
c) I have communicated to students the ethical principles for the protection of human subjects
and will review and monitor student assignments to ensure that human subjects are
protected.
d) This assignment is for educational purposes only and will not be presented or published by
the instructor or the students outside the University, and I am responsible for ensuring that
students understand that data collected for this project cannot be published or presented to a
professional audience.
Signature of Responsible Faculty Member
Date
Faculty should complete this form and mail original to the ORSP office, Row Hall 332, or scan and email to
irb@westga.edu. Please contact the Office of Research & Sponsored Projects at 678/839-4749 with any questions or
email irb@westga.edu. Review will take approximately one week.
UWG IRB Classroom Research Form
February 2012 (v.1.3)