Educational Research Informed Consent Waiver Request

Project & Investigator Information

Project Title Principal Investigator Department / Unit Email Phone

Description of Research

Brief description of the study and purpose Population targeted Number of participants

Waiver Request Details

Type of waiver requested

• Waiver of documentation of consent
• Waiver of informed consent

Justification for waiver (why informed consent should not be obtained, or documentation should not be required)

Risk and Benefit Assessment

Describe risks to participants Describe benefits to participants or others How are risks minimized?

Confidentiality

Describe how participant privacy and confidentiality will be protected

Additional Information

Any other relevant information?