IRB Forms
Download Investigator's Manual for Human Subjects Research
Download Applications for New Research:
Note: Applications are to be submitted via email attachment to compliance@mtsu.edu. Students must have faculty mentors email their applications with a statement of
approval. Please have applications submitted a minimum of 2 weeks prior to your project
beginning.
The compliance office will send a confirmation email that your application has been
received. If you do not recieve an email within 24 hours please contact our office
at 615-494-8918.
Instructions for filling out applications
IRB application for Full or Expedited Review
IRB Application for Exempt Reviews
IRB application for Interviews or Oral History Research
* Not sure which of these to use? See the Decision Chart or FAQ for information on whether your research will qualify for Exempt, Expedited of Full
Review.
Data Use Agreement Form
Download Current Versions of Consent and Assent Forms - Please fill out as word documents or in such a way where our stamp of approval may
be inserted to approved forms!!! Thanks!
Informed Consent Template
Interview Informed Consent Template
Parental Consent Form
Assent Template
Request Waiver or Alteration of Consent: Please note to alter or waive consent, you must provide justification to do so. Fill
out the appropriate portion of the Request for Waiver or Alteration of Consent and
attach it to your IRB application.
*Do not modify applications. Answer all questions completely and thoroughly. If you
feel a question does not apply to you state that and explain why. Do not leave any
questions blank. Incomplete applications will not be approved and will be returned
to you for completion.
Download Forms for Progress and Final Reports
IRB Progress Report / Final Report
Download Forms for Biological Specimens or DNA
Genetic Research Consent Forms
Application for Specimen Repository
If you are collecting Protected Health Information you will need to add additional language to your consent form, download a template
below.
If you or an institution you are affiliated with may make money related to your research
you need to add the Conflict of Interest Disclosure to your consent form, download below.
Language to be inserted into Informed Consent for Special Cases:
Confidentiality for Protected Health Information
Conflict of Interest Disclosure
Compensation for Injury for Funded Studies
Forms for IRB members
Download Supplemental forms for Vulnerable Populations:
Research involving Minors
Research involving Cognitively Impaired Populations
Research involving Prisoner
Please send all correspondence to:
MTSU Institutional Review Board (IRB)c/o Kellie Hilker
Sam H. Ingram Bldg. 011B
Murfreesboro, TN 37132
PH: 615-494-8918
FX: 615-898-5028
If you need to report a study-related injury, or if you have questions, please contact
the Compliance Officer, Kellie Hilker at compliance@mtsu.edu or 494-8918.
If you have any concerns regarding integrity and ethics in research and scholarship
at MTSU, please do not hesitate to call (615) 898-8918. The confidentiality of anyone
who contacts the office will be protected under the Whistleblower Protection Act. Working together we will promote the highest standard of integrity and ethics in
research and scholarship.
Compliance Officer
Sam H. Ingram Bldg. 011B
Murfreesboro, TN 37132
PH: 615-494-8918
FX: 615-898-5028
Email: compliance@mtsu.edu
2013 Middle Tennessee State University, a Tennessee Board of Regents institution 1301 East Main Street, Murfreesboro, TN 37132-0001 USA +1.615.898.2300
Middle Tennessee State University, in its educational programs and activities involving students and employees, does not discriminate on the basis of race, color, national origin, sex, religion, or age. Furthermore, the university does not discriminate against veterans or individuals with disabilities.
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