Pursuant to 45 CFR 46
COMPLETION FORM
e-mail to the IRB Chair
Lewis-Clark State College Institutional Review Board
Current IRB Approval Number
Principal Investigator(s):
my research.
Expiration Date
I acknowledge that this represents an accurate and complete description of
Name of Primary PI
Signature of PI
Date
Additional Researchers’ Names
Mailing Address
Telephone Number
Division
E-mail address
(Student's lcmail account)
Adviser (complete if PI is a student): I agree to provide the proper surveillance of this project to ensure
that the rights and welfare of the human subjects are properly protected.
Name of Adviser (typed)
Adviser’s Address
On original application, not needed here
Signature of Adviser
Adviser’s E-mail address
Date
Telephone
Title of Project
_____ Check here to report the completion of human participants’ data collection
_____ Check here to report that all data is now anonymous. (any identifiers have been removed or never
existed)
Electronically submit this page to the IRB Chair