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Institutional Review Board (IRB) Request

Prior to submitting this form, please familiarize yourself with Kalamazoo Valley's Institutional Review Board policies and procedures found HERE.

Principle Investigator Information

First Name

Last Name

Phone

Primary phone number

A copy of your response will be emailed to this address

Department

IRB Details

Title of IRB Project

Start Date

End Date

Is another IRB overseeing your research project?

Has your research project been approved by the host institution?

Please upload copies of your IRB approval letter.

Please upload a copy of your original IRB application and/or documents that provide an overview of your project and partnering institutions' involvement.

PLEASE NOTE:

Kalamazoo Valley requires all research projects supervised by other institutions to be approved by the host institution before participation will be considered. Please revisit this form and attach the required documentation once your project has been approved by the host institution's IRB.

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Are additional investigators involved in your research?

Additional Investigator Information

First Name

Last Name

Phone

Primary phone number

Department

Project Overview

What is the purpose of your research?

What methodologies will be utilized throughout the research?

What data will be collected throughout the duration of the project?

Please describe why Kalamazoo Valley subjects have been identified as key subjects for your research. Provide details on the specific subject types, demographics, etc. you will be targeting.

Please describe how your research be shared/distributed? Be specific describing the audience if known (e.g. Business instructors at KVCC will be provided access to the final report) and other details regarding the dissemination of your finalized research.

Risk Management

What foreseeable risks or discomforts do you anticipate for subjects?

What steps have you taken to mitigate risk to participants?

Describe how you will ensure participants' participation will be confidential and securely manage data related to your research project.

Consent

Code of Federal Regulations, title 45, part 46, section 46.116 (General requirements for informed consent) should be reviewed and understood prior to the submission of a research request. A copy of the consent form to be completed by research subjects should be provided alongside other required documentation for IRB review.

Informed consent must be collected by the investigator(s) from all subjects. The following information should be included on the consent form provided to each subject:

An overview of the research, including but not limited to:

The purposes of the research
The anticipated duration of the subject's participation,
A description of procedures to be carried out, including an indication of any procedures considered to be experimental

A description of any reasonably foreseeable risks or discomforts to the subject
Potential benefits to the subject or to others which may reasonably be expected from the research
A statement of confidentiality, describing how identifiable information will be retained, maintained or destroyed
A statement indicating that participation is voluntary
A statement indicating the right to withdraw or discontinue participation at any time
Contact information for those directly involved in conducting the research those supervising the research and a Kalamazoo Valley IRB point of contact
A signature line for verifying legal consent to participate

Upload a copy of the consent form to be distributed to subjects and collected by investigators.

Are there incentives for research participants? If yes, please describe them here.

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After research has concluded, I agree to provide relevant data, final reports and/or findings back to Kalamazoo Valley Community College. I will provide this information via email to the contact(s) listed on the college's IRB webpage.

Yes, I understand Kalamazoo Valley would like to receive a copy of my research once it is finalized.