FlowForms

Name

required

This form should be prepared by the Principal Investigator (PI) and attached to any research project proposal involving human subjects.

Email

required

Request For: (select one)

required

Full Review

Expedited Review

Limited Exempt Review Category

Exempt Review

Category

required

Study Title

required

Primary Investigator

required

Department

required

Phone Number

required

Choose your Affiliation with Oklahoma Wesleyan University

required

Faculty Member

Graduate Student

Undergraduate Student

Graduate

Human Subject Training is Required. Please upload a copy of your certificate.

required

Date of Successful Completion of Human Subject Training (must be completed in the past 12 months).

required

Signature required

Will you have a faculty sponsor?

required

Yes

No

Faculty Sponsor

Faculty Email

Study Procedures

required

Describe the problem or issue you hope to address in your research.

Briefly provide the explanation of the need for this proposed research.

required

Does your study involve an intervention?

required

Yes

No

Most projects involve an intervention (i.e. a change in practice based on evidence) as well as an assessment of the efficacy of that intervention.

If you will be analyzing existing data, choose yes. Additionally, any documents, policies, procedures, etc. that you will be reviewing and/ or analyzing for your research are also considered records.

required

Yes

No

Provide a detailed outline of your project plan.

required

Include specific details concerning all activities that will be part of your project.

Describe any data you will collect as part of your project.

required

The data you collect as part of your project should focus on success of the intervention and should not include private identifiable information. Note: The collection of any private identifiable data constitutes human subject research. Private identifiable data includes: medical and clinical records, results of test intended to measure participant knowledge, attitudes, behaviors, and beliefs, and interview or surveys seeking private information about the individuals participants. Private identifiable data typically does not include surveys or interviews that are intended to evaluate the efficacy of a program or intervention or which focus on organizational practices or social issues.

Describe any plans to inform individuals at the site about your project.

required

Will individuals have the opportunity to decide whether or not to participate in your project?

required

If your project involves an intervention that will occur organizationally or across the site as a whole explain that in your answer.

Describe any potential ethical concerns in the proposed activities or intervention.

required

How will you address the potential ethical concerns raised in the previous question?

required

Describe the intervention that you are implementing for your project.

required

In your response, be certain to provide as many details as possible. Such as: • What is the intervention? • What activities will they have completed pre- and post-intervention? • Will all participants receive the intervention? If not, how will participants be assigned to control or test group. • Are special qualifications needed to implement the intervention? Is so, describe your qualifications to implement it?

List all of the places at which the intervention will be implemented.

required

Owner of the Data Set

required

Includes name, title, address, phone number, etc. If the data set is publicly available include information on how the public may access the record.

Who will provide you with the data?

required

Include name, title, and phone number. If you are pulling the data from a database or internet site yourself provide details on how you’ll access the data.

Is this data publicly available?

required

Yes

No

Publicly available means that any individual is able to access the data without permission to do so.

What data is contained within the records?

required

Will information be provided to you de-identified?

required

Yes

No

De-identified means that all identifying information will be stripped from the records before they are given to you. If the information contained in the records are about an entity rather than individuals, choose ‘yes’ as identifying information refers to individuals not entities.

How will the data be provided to you?

required

For example, if you will access the data via a website give details and provide the URL. If you will be provided the data physically or electronically, detail the format and methods that will be used.

Have you received permission to use the records from the owner(s)?

required

Yes

No

Will the data collected in the course of the study be considered sensitive data?

required

Yes

No

E.g., Information about the participants’ psychological or mental health, illegal activities, HIV status, SSN, etc. Sensitive data should only be collected if vital to the data analysis.

Detail what sensitive data will be collected.

required

Examples of sensitive data include HIPAA protected information, FERPA protected information, information would/ could cause loss of reputation, employment, financial status, etc.

Describe how you will protect the confidentiality of data during the collection, transmission, and storage of data.

required

For example, coding or removal of identifiers as soon as possible, limitation of access to data, use of locked file cabinets, and protection of computer-based data systems, etc. Include specific procedures for all forms of data.

I understand that I am required by Oklahoma Wesleyan University policy and by regulations that I must retain all study data for a minimum period of 7 years. required

Describe how you will destroy the data after the 7-year period is over.

required

Are there reasons why the site(s) would need to be identified in the published research?

required

Yes

No

Sites must be identified to the IRB. However, in published research the site must be anonymized. You will need to refer at a minimum to the state in which the site resides (if it has a geographical location) and steps taken so that the reader cannot infer the site.

Describe how you'll protect the identity of participants while in your study and in your published research.

required

For example, all documents will be coded, you’ll use a pseudonym, you collected anonymous data via survey, etc.

Research Site Details

Provide the name of the organization about which you are collecting non-public information.

required

Site Location

required

Site Contact and Contact Information (phone number/ email)

required

Site Description

required

Have you received written permission from the site to conduct your research?

required

Yes

No

Facility Letter of Cooperation or Facility IRB Approval

required

row changed

please fill in the missing information

Informed Consent

required

Is there any additional information that you would like the IRB to know/ consider that you have not provided elsewhere in the application?

If there are additional documents that the IRB needs to review/ consider as part of its review, please list them here and upload them below.

Additional Documents to Review

By signing your IRB application stating that the information in this application is truthful and accurate to the best of your abilities and that this application is ready to be reviewed. required

IRB Application

For the last box (who the form is to be sent to) please select the instructor/ Faculty sponsor for your course or project.