IRB Survey-Based Research Application

1. Principal Investigator Information

Full Name

Email

Department

Phone

2. Project Title

3. Co-Investigators (if any)

4. Project Summary

5. Purpose and Objectives

6. Survey Instrument Description

7. Study Population

Describe target population Recruitment process Sample size

8. Data Collection Procedures

9. Data Storage and Confidentiality

10. Informed Consent Process

11. Risks and Benefits

Risks to participants Benefits to participants

12. Attachments

Survey Instrument

Informed Consent