INSTITUTIONAL REVIEW BOARD
CALIFORNIA STATE UNIVERSITY SAN BERNARDINO
Application to Use Human Participants in Research
1. PROJECT REVIEW
X Complete CITI Course in Human Subject’s Online Training before submitting IRB application (see IRB website for policy at http://irb.csusb.edu/).
X New Project (ID# will be assigned by the IRB)
o Revised Project (Enter IRB ID#)
o Renewal (Enter IRB ID#)
Approximate date of most recent previous review of this project _____________
2. DATA COLLECTION DATES: From 09/01/09 To 12/31/09
This is required information, must be future dates – after you have received final IRB approval to conduct your research.
3. INVESTIGATOR(S) NAME(S) _Angelica Villanueva_______________
Department _________________________ Phone ___________________
Student(s)/Researcher(s) E-mail Address(s): __villanua@csusb.edu___________
If you are a student, please provide the following information:
This research is for X Graduate Thesis & Projects o Honors Project
o Independent Study o Course ___________
o Other ____________
4. PROJECT TITLE Temporary Staff Training
5. DESCRIPTION OF PARTICIPANTS (Enter approx. no. of participants and categories that apply)
Number 0 Gender: o Female o Male
- o CSUSB Students o Children (17 or younger) o Child Development Center
- o Prisoners o Patients in institutions o Pregnant Women
- o Other _________________
6. IS FUNDING BEING SOUGHT FOR THIS RESEARCH?
o Yes X No
If yes, you must submit one complete copy of that proposal as soon as it is
available and respond to the following questions:
Does the funding agency require notification of Institutional Review Board approval? o Yes o No
(If yes, please provide the IRB Secretary with one copy of all relevant forms, instructions, etc., with your original copy of this application.)
Project period from ______________ to _______________
7. INDICATE THE REVIEW CATEGORY FOR WHICH YOU ARE APPLYING.
X I am applying for administrative review (formerly exempt review), based on the following category (ies):
(Check all that apply. Submit an original and one copy of all application materials to the IRB.) Note: Research involving children must be reviewed FULL BOARD.
X Research conducted in established or commonly accepted educational settings and involving normal educational practices
- Research involving the use of educational tests, if information from these sources is recorded in such a manner that participants cannot be identified in any way
- Research involving survey or interview procedures where participants cannot be identified
- Research involving the observation of public behavior where participants cannot be identified
- Research involving the collection or study of existing data, documents, records, pathological specimens, or diagnostic specimens, where these sources are publicly available or where participants cannot be identified
- I am applying for expedited review, based on the following category(ies):
(Check all that apply. Submit an original and 1 copy of all application materials to the IRB.)
- Collection of hair, nail clippings, teeth in a non-disfiguring manner.
- Collection of excretal and/or external secretions.
- Recording of data from adults using noninvasive procedures.
- Collection of moderate levels of blood samples from adults in good health.
- Collection of supra- and sub-gingival dental plaque and calculus.
- Voice recordings made for research purposes.
- Moderate exercise by healthy volunteers.
- Study of existing data, documents, records, or pathological or diagnostic specimens.
- Non-manipulative, non-stressful research on group or individual behavior.
- I am applying for full board review.
(Submit an original and 1 copy of all application materials to the IRB.)
8. ATTACHMENTS. I have included copies of all relevant project materials and documents, including (check all that apply):
X Surveys, questionnaires, and/or interview instruments.
- Informed consent forms or statements.
- Letters of approval from cooperative agencies, schools, or education boards.
- Debriefing statements or explanation sheet.
- Participant recruitment materials, including flyers and advertisements.
9. AFFIRMATION OF COMPLIANCE:
I agree to follow the procedures outlined in the summary description and any attachments to ensure that the rights and welfare of human participants in my project are properly protected. I understand that the study will not commence until I have received approval of these procedures from the IRB or where appropriate a department Human Participants Review Board; I have complied with any required modifications in connection with that approval. I understand that additions to or changes in the procedures involving human participants, or any problems with the rights or welfare of the human participants must be promptly reported to the IRB. I further understand that if the project continues for more than one year from the approval date, it must be re-submitted as a renewal application.
*NOTE: You (the investigator/researcher) are required to notify the IRB if any substantive changes are made in your research prospectus/protocol, if any unanticipated adverse events are experienced by subjects during your research, and when your project has ended. Important: If your project lasts longer than one year, you (the investigator/researcher) are required to notify the IRB by email (mgillesp@csusb.edu) or correspondence of Notice of Project Ending or Request for Continuation at the end of each year. See the IRB website for the proper 1 page form at http://irb.cusb.edu/. Failure to notify the IRB of the above may result in disciplinary action under the CSUSB campus student and faculty misconduct policy. You are required to keep copies of the informed consent forms and data for at least three years.
*(Required for all investigators):
I affirm the accuracy of this application, and I accept responsibility for the conduct of this research, the supervision of human participants, and maintenance of informed consent documentation as required by the IRB.
__Angelica Villanueva ____ _villanua@csusb.edu_______ ____05/23/09______
Signature of Investigator Your e-mail address Date
________________________________ ________________________ _________________
Signature of Co-Investigator(s) Your e-mail address Date
APPROVAL OF FACULTY ADVISOR/SPONSOR
*(Required for all faculty advisors) By signing – you as faculty advisor affirm the accuracy of your students application and accept responsibility for the conduct of this research, the supervision of the researcher (student) in ethical conduct of research, and maintenance of informed consent documentation as required by the IRB.
_________________________________ _________________ _____________________________
Printed Name of Faculty Advisor/Sponsor Campus Phone E-mail of Faculty Advisor
_________________________________ _________________
Signature of Faculty Advisor/Sponsor Date
APPROVAL OF A LICENSED PHYSICIAN (Required only if the project involves medical procedures and neither the investigator nor the faculty/advisor is a licensed physician)
________________________________ _________________
Printed Name of Licensed Physician Contact Phone
_________________________________ _________________
Signature of Licensed Physician Date
Please Re-type the headings and answer in your own words (given below in boldface type) for questions 10 through 15 and use as many separate sheets of paper as you need to respond fully. DO NOT COPY THESE PAGES AS PART OF THE APPLICATION. Attach the appropriate forms as requested in 14 and 15.
10. PARTICIPANT RECRUITMENT.
The potential participants I will use are full-time credentialed teachers and substitute teachers from the Coachella Valley Unified School District. The credentialed teachers will have a minimum of three years of teaching experience in a K-12 educational setting and the substitutes will range from newly hired to participants that have been active for years.
11. PROJECT DESCRIPTION.
My project will attempt to create effective and efficient training of substitute teachers. The data collected for this project will be used to improve the product that results from the development. My objective is to identify dimensions of and attempt to improve a lack of training and preparedness of substitute teachers.
Data Collection: I will create a writers guide and request that teachers complete the questions and provide examples of their expertise in classroom management and school procedures. This data will be used to create a training module that would enhance the substitute teacher’s knowledge of proper procedure and allow the substitute teacher to be productive in the classroom.
12. CONFIDENTIALITY OF DATA.
Data collected will retain no identifiable characteristics.
13. RISKS AND BENEFITS.
There are little or no immediate long-range risks to participants. The topics of this project are not sensitive or in any way controversial. The benefits of this study for the participants would be better training for the temporary staff that takes over their classrooms in their absence. The children in these classrooms will benefit from a better trained substitute teacher.
14. INFORMED CONSENT.
I am requesting permission to waive record keeping of informed consent.
15. DEBRIEFING STATEMENT.
I will not be using deception in my study so there is no need for a debriefing statement.
