Appendix: Materials Provided to Students to be Tailored to their Projects
Project Summary Template
A11 students will submit this form for review through the delegated review process
The following sample protocol template has been approved by IRB for Delegated Review and
should be modified as necessary to fit specific course projects. It should form the basis for the
research proposal assignment description provided by the instructor to students in his or her
course.
YOUR NAME
YOUR PROJECT TITLE
Please answer all of the following questions as they relate to your proposed study. Use the
heading above, and follow the format below exactly (including numbering and subject headings.)
1. Topic/Research Question: What is the topic of your research? What is your research
question?
METHOD (Identify One)
Face to Face Survey
Online Survey
Questionnaire Survey
Experiments
Field Observations
Analysis of Secondary Data (exempt, no need to fill in any other information)
Content Analysis (exempt, no need to fill in any other information)
Other ___________________________
2. General Information: Where (give specific locations on campus) and when (give specific
dates) will your study be conducted?
3. Ethics/Risks: What potential risks or discomfort (i.e., physical, emotional, and/or social)
might subjects experience by participating in your study? Does your topic deal with a
sensitive issue? Could your subjects be embarrassed? Could your subjects recall any
emotionally disturbing experiences? Does your survey ask subjects to admit to engaging in
illegal activities?
If there are risks, how will they be minimized? (One way risks are managed for members of
the Ithaca College community is to provide subjects with the Counseling Center phone
number: 274-3136.)
4. Subjects: Who are your subjects? What demographic characteristics will they possess?
(NOTE: SUBJECTS MUST BE AT LEAST 18 YEARS OLD.)
5. Selection of Subjects: How will you choose your subjects? Where will they be recruited?
How long will the survey take?
6. Anonymity: You should not include any identifying information (i.e., subjects’ names, ID
numbers, code numbers, etc., on the questionnaires. (Subjects should be instructed NOT to
put their names on the survey.) How will questionnaires be returned to you so that neither
you nor anyone else will know which subject filled out which questionnaire? You should not
let anyone else (including the professor) see any subject’s questionnaire. Indicate how data will
be stored (faculty advisor's locked desk in room 603b for 3 years).
7. Recruiting of Subjects: What will you say to people when you ask them to participate?
You should include an explanation of the purpose of your study and advise them of any
potentially sensitive topics to be addressed. You should tell them that their anonymity and/or
confidentiality will be assured. In addition, you should tell them that they can refuse to
answer any questions and that they may withdraw from the study at any time. You should
also inform them that they must be at least 18 years of age or older to participate.
8. Introduction: You must attach a tear-off over page to your survey explaining all of the
following (see sample provided):
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that this is a class project;
what the topic of the survey is;
any sensitive issues/questions;
that subjects may skip questions or withdraw from the survey at any time;
that subjects must be at least 18 years of age
how long the estimated total participation time is;
that subjects should not put their names or ID numbers on the survey;
how and when subjects should return the surveys;
the Counseling Center phone number (for those projects dealing with sensitive
issues);
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your name and your faculty advisor’s name and contact information;
that subjects should tear off the cover page and keep it for their information
9. Expected Outcomes: How will the results of the study be disseminated (e.g., course
project, course assignment, thesis, publication, conference presentation, etc.)?
All teams must have the final version of their survey approved by the instructor before
collecting any data. The final version of the survey will be attached to the approved protocol.