Human Subjects Review Board
 
  
 

Contact Info:
Monie Hayes
Assistant Professor of Educational Studies
HSRB Chair
Wallace Hall
Rm. 202
309-457-2153
 mlhayes@monm.edu
 
 
  Online Submission Form
 


Application for Approval to Conduct Research at Monmouth College

  • All investigators must request a review of their studies to be made by the HSRB Committee prior to conducting research unless the research is conducted solely for the purpose of teaching.
     
  • All researchers must meet certain ethical standards.
     
  • The Committee will make use of the information provided below to review each research proposal.
     
  • The Committee will submit approvals, requirements for changes, or disapprovals to the investigator in writing.
     
  • Approvals are valid for one year from the date of approval unless otherwise specified.
NOTE: Please print the Form Confirmation results page that will be displayed after you submit the form, so that you will have a copy of what you submitted.
Name of Investigator: 

 

Name(s) of Collaborator(s):

 

Faculty Sponsor (for students):

 

Title of Research Project:

 

Below, please provide a brief description of your research project (no longer than 1 page). This summary should be brief, but detailed enough so that the committee can understand all methods by which you plan to collect data.


1. Have you read your discipline's ethical standards pertaining to research with human subjects and/or sought the advice of scientific colleagues regarding ethical acceptability?

Yes  No

2. What benefits will be gained from this research?


3. Will concealment or deception be used in this research?

Yes  No

4. Is subject participation voluntary and confidential?

Yes  No

5. Please cut and paste a copy of the Informed Consent form to be used in this study.


6. How will consent be obtained?

Written  Orally

7. Are subjects of sufficient age and competence to make an informed decision regarding their participation?

Yes  No

8. Are subjects at any risk physically or psychologically?

Yes  No

* If YES, describe the possible discomfort, harm, or danger:


* If YES, what measures have been taken to inform the subject?


9. Will the subject be informed about how to contact the investigator should stress, potential harm, or related questions arise?

Yes  No

10. By what methods will the purpose of the research be clarified for the subject (if deception is used, this is particularly important)?


11. Are the anonymity of the subjects and the confidentiality of their data protected?

Yes  No
* If NO, by what method are subjects informed of this prior to their participation?


To the Investigator:

Remember to attach to this form:
  • (a) an abstract giving a full description of the proposed study, purpose of the research, and the method of subject selection; and
     
  • (b) a written version of the Informed Consent in the case of human subject participation.

If you are using surveys or questionnaires, please attach copies of these materials to this form. Further explanation of the points above that you may feel are important and/or necessary for consideration during the review by the HSRB should also be provided. Attach pages with additional information to insure full and proper consideration.


Certification

I have read and am familiar with the policies and procedures for conducting research at Monmouth College. I certify that the information presented above is accurate and complete. I also certify that, in the event that the conditions and/or procedures of the proposed research undergo substantial change, a new approval form must be submitted to the Ethics committee before research activity may proceed.

Approval of this research does not remove liability from the responsible investigator.
 
Investigator Name:

 

Date:

 

Faculty Sponsor Name:

 

 Please Note:  Print and save a copy of the results page that will display after you click submit.

   

   

 

Human Subjects Review Board    
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