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Institutional Review Board Application
General Information
1.
Name of principal investigator:
2.
Phone Number:
3.
Email address:
4.
Is the principal investigator affiliated with Chesapeake College?
Yes
No
5.
If yes, in what capacity?
6.
For the purposes of this research is the principal investigator affiliated with another institution?
Yes
No
7.
If yes, which institution and in what capacity?
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)
9.
Study Title:
10.
Purpose of request, e.g., master’s thesis, dissertation:
11.
Affected Chesapeake Department (if applicable):
Current Progress,
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