Request to Use Subjects from the Psychology 120 Subject Pool
IRB Research Project Number
Sona Systems Number(s) _____________
1. Title of protocol and the title to be used with the PSY 120 subject pool, if different:
___________________________________________________________________________
2. List every person who will have contact with subjects, as well as their capacity (e.g., experimenter, assistant,
or confederate). Attach an additional page if necessary. Email addresses are required for new sona accounts.
FULL NAME
FAC/GRAD/UNDRGRD
__________________________ ____ ____ ____
__________________________ ____ ____ ____
CAPACITY
_______________
_______________
EMAIL ADDRESS
__________________
__________________
3. Attach the description of your study’s procedures that you plan to post to the Sona Systems program. This
description must provide enough information to potential subjects so they will have a basic understanding of
what they can expect when participating in your study. List everything you plan to post to the Sona program,
including restrictions, duration of the session and experiment credits to be awarded.
4. Attach 3 copies of your informed consent document that include the IRB Research Project Number at the
upper left; and the Sona Systems number(s), and the title to be used with the PSY 120 subject pool centered
under the heading Research Participation Consent Form. These 3 copies will be stamped by the Experiment
Coordinator. One copy will be returned to you for your use, one copy will be retained in the department’s
files, and one copy will be sent by the Experiment Coordinator to the IRB for their files.
5. Attach a debriefing document (and script if you plan to debrief orally). NOTE: PSY 120 textbook
references must be updated each semester noting which text is used by each instructor. Current textbooks
and lists of instructors are available in the PSY 120 Experiment Coordinator's office. This document must
also include two outside references, no more than one of which can be a book. This debriefing requirement
provides a learning experience for the participant and reduces participant apathy (and hostility).
NOTE: You must use the same title on everything subjects will see, e.g., the title used in the Sona Systems
program; the consent form(s), and the debriefing document.
This request is based on a research protocol which has previously been approved by the Department of Psychological
Sciences’ Human Subjects Advisory Group and by the Purdue University Institutional Review Board (IRB) and is
considered to be in active status by the IRB. This research will be conducted in accordance with all Federal, State,
University, and Department procedures and regulations.
___________________________________________
Major Experimenter
E-mail address:___________
___________________________________________
Principal Investigator (faculty member)
Date: ___________________
___________________________________________
Chair, Human Subjects Advisory Group
_______________________
Date
Rev: 03/06/16