CERTIFICATE OF TRANSLATION FORM
Version 2015.a
For research conducted in languages other than English, the Rutgers IRB must have all versions of the
research material [e.g. consents, recruitment, instruments, etc.] in both English and non-English to be
retained in the research file. A certificate of translation form is also required to verify the translations
are accurate. Those who translate the material are to provide a brief description of their qualifications,
skills or experience for serving in this role and sign the certificate of translation form.
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Translation: It is acceptable for an investigator listed as research personnel to translate the
research material.
Timing of the Translation: the research investigator(s) may wish to delay the initial translation
until after the IRB has reviewed the English versions. Doing so may help researchers avoid
multiple translations.
Modifications: If the non-English documents are submitted to the IRB after initial approval,
please submit a research modification form along with the translated material and a copy of the
certificate of translation.
Name of Principal Investigator
Name of Faculty Advisor (if Student)
Protocol Title
Protocol Number
Name of Translator
Phone Number
Email:
Language(s)
Certified Translator (Mark one): [ ] YES [ ] NO
If YES, please provide the name of the organization providing certification
If NO please provide foreign language proficiency to serve as a qualified translator or
interpreter (e.g., it is my native language, I have X number of years of education and training in this
foreign language, or I have other evidence of dual language fluency.)
Please explain and attach resume indicating translation skills & experience, as applicable.
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Name of Document(s) translated (please include version and/or date if applicable or other
document identifier:
PI Certification
By signing below or submitting this document electronically, I agree to accept primary responsibility for
the scientific and ethical conduct of this project as approved by the IRB. The proposed changes (for
translations) cannot be made until you receive documentation of IRB approval.
I, the undersigned verify that all translated materials related to the above named study
reflect the intent and spirit of the English text.
Signature of Principal Investigator
Printed Name
Department
Date
FOR STUDENT INVESTIGATORS:
A Rutgers faculty advisor’s signature is required or this document must be submitted electronically by
your faculty advisor.
Faculty Supervisor: By signing below or by submitting this document electronically, I certify that I have
reviewed this document and approve the proposed changes and continue to approve of the scientific
and ethical aspects of the project. I will supervise the above listed student and ensure compliance with
human subjects’ guidelines.
Signature of Faculty Advisor
Printed Name
Department
Date
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