Translator Declaration Statement

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Vanderbilt University Institutional Review Board

Translator’s Declaration

IRB#:

PI:

To the Vanderbilt University Institutional Review Board:

I, ____________________________ declare that I am fluent in and understand the English language and the __________________________ language. To the best of my knowledge and belief, the attached translation(s) are true, accurate and correct.

Attached are (1) the original documents (In English) and (2) the __________________________

- translated version(s).

Other than my role as a translator, I have no other involvement with the above-referenced research proposal.

Translator’s Name (Print): _________________________________________________________

Address: _______________________________________________________________________

Phone No.: (_____) - ______ - __________ Fax No.: (_____) - ______ - _________________

E-mail: __________________________________________

_________________________________________________ _______________________

Signature Date

IRB Form #1128, Translator’s Declaration

Version Date: March 1, 2006

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