University of Colorado at Colorado Springs
Proposed Starting and Ending Dates: to
Signature of Investigator*____________________________ Date: ___________
Type of Review Requested Refer to the policy and procedures for specific information about each type of review. _____Exempt _____Expedited _____Full
Attach Research Summary and all consent documents.
At OSP ______________ IRB # _________________
Action: ____Approved ____Approved w/ Revision ____Disapproved
Signature IRB Chair ________________________________ Date:___________
* Your signature indicates that you have reviewed and approved this application for forwarding to the IRB and accept responsibility for the research described, including work by students under your direction. It further attests that you are fully aware of all the procedures to be followed, will monitor the research, and will notify the IRB of any significant problems or changes.