Request for Ethical Review of Research on Human Subjects.docVIP

Request for Ethical Review of Research on Human Subjects Title of the Research Project: Tracking Number: Federal regulations and Saint Xavier University policy require that all research involving humans as subjects be reviewed and approved by the University Institutional Review Board (IRB) prior to conducting the research. As of June 30, 2014, the IRB will not review any research project submitted without documentation of mandatory CITI training or NIH training for both investigators and faculty sponsors. For information on training requirements, human subjects research policies, forms, and templates, please visit the Saint Xavier University IRB website. Please refer to the SXU-IRB Application Checklist in completing your application. /academics/resources/irb/index.asp Principal Investigator (Primary Contact) CITI Or NIH Certificate Name: School/Department/Office: Phone: E-mail: CITI code: NIH number: Co-Investigator Name: School/Department/Office: Phone: E-mail: CITI code: NIH number: Co-Investigator Name: School/Department/Office: Phone: E-mail: CITI code: NIH number: Co-Investigator Name: School/Department/Office: Phone: E-mail: CITI code: NIH number: Co-Investigator Name: School/Department/Office: Phone: E-mail: CITI code: NIH number: Faculty-Sponsor (if applicable) Name: School/Department/Office: Phone: E-mail: CITI code: NIH number: Phone numbers and e-mail addresses are required for all investigators and faculty sponsor. Location(s) where research will be conducted: Location Name/ Address: Location Name/ Address: Location Name/ Address: Location Name/ Address: Location Name/ Address: Funding Source: Yes___ No___ Will funding source create a conflict of interest? Yes___ No___ Do researchers anticipate any conflict of interest? Yes___ No___