Status Report for
Exempt Projects
Office of Research and Sponsored Programs
1 UNF Drive
Jacksonville, FL 32224-2665
904-620-2455 FAX 904-620-2457
Equal Opportunity/Equal Access/Affirmative Action Institution
MEMORANDUM
DATE:
TO:
FROM:
RE:
Exempt Status Report for IRB#
Project Title “
”
1. Details of any adverse or unexpected problems/side effects that have occurred or that are
expected (if none, then please state none):

2. The total number of participants who discontinued their participation and a summary of the
reasons for the withdrawals (if known):

3. A summary of any complaints about the research from subjects or others since the initial IRB
review:

4. New information that could affect the risk/benefit ratio for this project (e.g., significant new
findings (published or unpublished) that developed during the course of the research which may
relate to the subjects’ willingness to continue participation). This includes any changes in the
investigator’s situation or qualifications (e.g., institutional affiliation, change in professional
license and/or certification status, significant increase in the number of research studies
conducted by the investigator):

5. A summary of the research progress to date:

6. Information regarding any changes to the approved project (if none, then please state none):

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Revised 9/25/2013
Additional comments/clarifications for reviewer (if applicable):
Investigator Acknowledgment:
This report has been personally reviewed and assessed by the principal investigator. By submitting this
form, the Principal Investigator assures that all information provided is accurate. He/she assures that
procedures performed under this project will be conducted in accordance with the requirements outlined
on the Declaration of Exempt Status memo associated with this project as well as all applicable
University of North Florida policies and procedures that govern research involving human subjects.
He/she acknowledges that he/she has the resources required to conduct research in a way that will
protect the rights and welfare of participants and that he/she will employ sound study design which
minimizes risks to subjects. The Investigator’s signature on this submission affirms this statement.
Principal Investigator Signature (please type name):
Date:
Faculty Advisor Signature (please type name):
(Only required for student projects)
Date:
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Revised 9/25/2013