Institutional Review Board Application

General Information

Question Title

* 1. Name of principal investigator:

Question Title

* 2. Phone Number:

Question Title

* 3. Email address:

Question Title

* 4. Is the principal investigator affiliated with Chesapeake College?

Yes

No

Question Title

* 5. If yes, in what capacity?

Question Title

* 6. For the purposes of this research is the principal investigator affiliated with another institution?

Yes

No

Question Title

* 7. If yes, which institution and in what capacity?

Question Title

* 8. If applicable, have you applied for or received approval for your study from another institution?

Yes, approval received

Approval in process

Process not yet begun

Not applicable (specify)

Question Title

* 9. Study Title:

Question Title

* 10. Purpose of request, e.g., master’s thesis, dissertation:

Question Title

* 11. Affected Chesapeake Department (if applicable):