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Please save and email copy to irb@ithaca.edu
INSTITUTIONAL REVIEW BOARD FOR HUMAN SUBJECTS RESEARCH
PROPOSAL
Before submission, delete all instructions that are in red.
1. General Information:
a. Funding:
b. If externally funded (federal or state funds), please list CITI certification date of ALL
researchers: (Please note that the proposal will not go to committee without CITI
certification)
c. Location:
d. Time Period:
e. Expected Outcomes: (What you plan on doing with the information (i.e., present at a conference, publish in a journal,
etc.)
2. Related Experience of Researchers:
(Specify the research experience and/or training of ALL researchers. If students do
not have research experience, state the degree of faculty oversight.)
3. Benefits of the Study: (What benefits will the researcher acquire through completion of the research (completion of class
assignment, potential for scholarly publication)? What benefits will the participants receive (enhances understanding, baseline measure of
fitness, etc.)? If no benefits, please state.)
4. Description of Participants
a. Number of participants:
b. Salient Characteristics:
(What characteristics do all subjects share (e.g. female varsity athletes)? Include age range of participants (e.g., 18 years of age or
older). Are there any exclusionary criteria (circumstances under which someone would be prohibited from participation). Specify
how you will determine if a potential subject should be excluded from the study.
5. Description of Participation Tasks and procedures- include amount of time for each task and a total estimated time.
If your study involves deception and it is necessary for the research design, please clearly explain here (e.g., I don’t want subjects to know
because ____________)
6. Ethical Issues:
a) Risks of Participation:
Virtually all research involves some risk even though it may be very minimal. A clear explanation of any risks (physical, psychological,
social, legal, or economic) that may occur as a result of participation. In the case of biomedical or behavioral research that may
result in physical injury, information should be provided regarding the availability of emergency medical treatment, and what that
treatment would likely be. In the case of social or psychological research that may result in emotional distress, an explanation should
be provided as to the availability of counseling or other resources.
b) Have you attached an Informed Consent Form or Tear-Off Cover Sheet for anonymous
surveys?
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7. Recruitment:
a) Procedures
How and where will subjects be recruited? For example will they receive a phone call at home, a letter, or an e-mail addressed to
them personally? Will they be solicited by mail (including email) or by a general announcement directed at a group in class? Will
they respond to a flyer posted in a residence hall or be referred by some other person? Will they be approached one on one?
b) Inducement to Participate/Extra Credit
Will subjects receive extra credit in a course for their participation? If yes, how and by whom will the credit be determined? How and
when will it be reported to the instructor? What options exist for students who wish to earn credit but do not wish to participate in
the research?
Please note that researchers cannot personally recruit in their own classes but may use a proxy student/staff member or
collaborator. The proxy recruiting in classes may not mention faculty names with respect to who is running the study.
Stipends - Since participation involves tasks completed over time or through multiple interactions, making compensation entirely
conditional on the completion of multiple procedures could undermine a participant’s ability to withdraw at any time. Payments
should be prorated, and subjects who are not able to complete the research should receive compensation proportional to their
participation, regardless of whether they withdraw or are withdrawn by the researchers.
8. Confidentiality/Anonymity:
Make sure you specify how data will be stored, how confidentiality/anonymity of data will be
maintained, and disposition procedures.
The Principal Investigator is responsible for keeping records related to the project, if approved, for a period of three years. Records include all
correspondence with the IRB (including the complete, approved Request for Review or Application for Exemption), all documentation of
informed consent, and any lists used in assigning codes or other identifiers to participants. Researchers may keep, at their discretion, completed
data collection instruments provided they continue to be protected in the manner specified.
9. Debriefing:
There are three cases in which debriefing is required: First, when there has been deception involved in the study. Second, when subjects may be
left with a misleading or potentially harmful perception or inaccurate information. And, third, when compensatory treatment or follow-up is
indicated. Debriefing may consist of providing the participant information about the deception and/or correct(ed) information, either in writing
or orally. The participant must have an opportunity to ask questions of the researcher at any time following the debriefing. This requires that
the participant be reminded that the information can be found in written materials provided during the consent process. If this does not apply
to your study, simply put N/A.
10. Compensatory Follow-up:
In cases where some physical or psychological harm might result from the subjects' participation, plans for compensatory treatment or follow-up
counseling should be described in the Request for Review. Only subjects who are from the Ithaca College community should be directed to
contact the Ithaca College counseling or health centers. Referral to appropriate professionals should also be considered if the researcher,
through the course of the research, uncovers a pre-existing condition warranting professional intervention. If this does not apply to your study,
simply put N/A.
Proposed Date of Implementation:
Signature of Principal Investigator:
________________________________________________________________
Electronically submitted protocols must be sent from an Ithaca College e-mail account. Original
signatures are not required. Ithaca College e-mail IDs have been deemed by the College to constitute a
legal signature.
PLEASE NOTE THAT YOUR PROPOSAL WILL BE DEEMED INCOMPLETE UNLESS COPIES OF ALL
INSTRUMENTS TO BE USED (SURVEYS, ETC.) AND INFORMED CONSENT FORM (IF NECESSARY) ARE
SENT TO irb@ithaca.edu.