Request for IRB Review

IRB Cover Sheet - Word format

University of Colorado at Colorado Springs

Investigator Name:
Department or Other Affiliation:
Campus Address:
Phone Number:                                         E-mail:
Title of Research Proposal:

Proposed Starting and Ending Dates:               to             
Is this project currently sponsored? Yes:       No:         Source:    
Are you submitting proposal for future funding? Yes:       No:    
Proposed Source of funding:

Signature of Investigator*____________________________ Date: ___________
Check One: ____Faculty/Staff ____Graduate Student ____Undergraduate Student
If investigator is a student, is this project being conducted to fulfill course requirements?
Yes:       No:     
Signature of Faculty Sponsor* ________________________ Date __________
Typed or Printed Name of Faculty Sponsor:

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.