IRB Application for Review

This form supports the following browsers: Chrome, Firefox, and Safari

Please complete this online application for submission to the Pitzer IRB.

Please be advised that you will not be able to start and stop the application process before submitting it. Thus, we recommend that you have all of your IRB materials prepared in advance of beginning this electronic submission process.

Items marked by an (asterisk*) are required for processing your application.

*Is this the first time you have submitted an IRB application for this project, or is this a revision or continuation of a prior application: (Choose one)
First time submission of this application
Revision of an application not previously approved
Revision or modifiation of an application already approved
Continuation
Continuation. If data collection has ended and no adverse events have occurred since the last IRB review, the research project no longer needs to undergo continuing IRB review. If data collection is active and extends beyond the date approved by the Pitzer IRB, a request for continuation of IRB approval should be sent to irb@pitzer.edu. Your request should include the following information:
  • Name of principal investigator
  • IRB ID number
  • Title of research project
  • The current state of data collection, including how many additional participants will be recruited
  • Whether any changes in data collection are being requested
  • And, notification of any adverse events that have occurred since the last IRB review.
*Principal Investigator (PI)
*First Name *Last Name
*IRB ID #
Forgot your IRB ID?

*IRB ID #
Forgot your IRB ID?

*Email (Please use your college-issued email)
*Phone
- -
*Field Group or Department (& Institution if non-Pitzer)
*Choose One:
Faculty at Pitzer Faculty at other institution
Staff at Pitzer
Student at Pitzer Student at other institution
Other
Pitzer ID # (8-digit)
*Faculty Advisor for Research (required for students)
*First Name *Last Name
*Faculty Advisor Email
*Faculty Phone
- -
*Title of Research Project
*Proposed Begin Date
*Anticipated End Date
Please check the box if any of the following are involved in your research:
Patients as participants
Minors as participants (under 18)  
**Note: You must upload a parental consent and a minor assent form to the "Upload content forms" in the File Upload section below.

Need a sample consent/assent form?
Informed Consent Form
Parental Consent Form
Minor Assent Form (6 and under)
Minor Assent Form (7-13)
Minor Assent Form (14-17)

Elderly participants (over 65)
Non-English-speaking participants
**Must provide all recruitment, consent, and debriefing materials in the additional language(s) in upload section below.
Cognitively impaired participants
Prisoners or parolees
Participants in other countries
**Please note that because your application deals with research in a foreign country, approval of this application means only that it meets the standards established by the Pitzer College Institutional Review Board for conducting research with human participants in the United States. This IRB has neither the authority nor the competence to grant permission for you to conduct research in a foreign country. It is the responsibility of principal investigators to familiarize themselves with legislation about the conduct of research with human participants in all countries in which they carry out such investigations and, where appropriate, to seek the appropriate permissions from agencies within those countries.
Greater than minimal risk to participants
Film, video, or voice recording of participant
**You must provide explicit directions of the use for film, video, or audio recording data in your consent form.

Need a sample consent/assent form?
Informed Consent Form
Parental Consent Form
Minor Assent Form (6 and under)
Minor Assent Form (7-13)
Minor Assent Form (14-17)

Questionnaires (surveys)
Use of previously collected data (e.g. Data banks archives, or medical records)
Plans to archive your data (e.g. in oral history or neuroimaging database)
**You must provide explicit directions of the use of archive data in your consent form.
Payment for participants (e.g. Each participant will receive payment/compensation)
Raffle (e.g. Some participants will receive payment/compensation)
Interviews
The use of drugs or medication
The taking of physical specimens
The use of deception
**Must submit debriefing materials in the File Uploads section below.
File Upload Checklist
Please check the following that is included with your application. (*All checkboxes must be filled)
Research Summary
(Need directions?)
Yes   No   Does not apply  
Consent Forms Yes   No   Does not apply  
Assent Forms Yes   No   Does not apply  
Recruitment Materials Yes   No   Does not apply  
Applicant NIH Certificates Yes   No   Does not apply  
Faculty NIH Certificates Yes   No   Does not apply  
Completed and signed organizational consent form Yes   No   Does not apply  
Language translations of research materials Yes   No   Does not apply  
Debriefing statement/Post Consent Yes   No   Does not apply  
NIH certificates for other investigators Yes   No   Does not apply  
IRB approval letter from another institution if project has been approved elsewhere Yes   No   Does not apply  
File Uploads
Note: A total maximum size of 20 MB per application is allowed.
*Please upload all materials marked with "Yes" into one Word document file from the File Upload Checklist. In addition, each page must be numbered.

(Optional) Upload any materials that cannot be included in your Word document submission above.

Note: Only the following file types are accepted: aiff, bmp, doc, docx, gif, jpg, mov, mp3, mp4, pdf, png, ppt, pptx, rar, txt, wav, xls, xlsx, zip

Upload additional materials
Upload additional materials
Upload additional materials
Upload additional materials
Upload additional materials
Upload additional materials
Upload additional materials
Upload additional materials
Upload additional materials
Do you need to upload additional materials?

IRB and NIH Confirmation
The IRB requires that the principal investigator, faculty sponsor, and research team members have read the Belmont Report and taken the NIH training course. Please indicate your compliance below.

By checking this box, I confirm that I have read the Belmont Report and completed the NIH online training course.
*Yes, I confirm

By checking this box, the principal investigator assures the IRB that all procedures carried out under the project will be conducted by persons legally and responsibly entitled to do so, and that any deviation from the submitted project (change in PI, participant recruitment procedures, research methodology, etc.) will be submitted to the IRB for approval prior to implementation
*Yes, I confirm

For Students:
By checking this box, the principal investigator confirms that the attached research summary has been reviewed by the faculty advisor prior to IRB submission.
*Yes, I confirm

By checking this box, I confirm my faculty supervisor has NOT previously submitted a certificate for NIH ethics training or equivalent and I will need to upload my faculty supervisor's NIH ethics training certificate. All NIH certificates need to be included in the single Word document that is uploaded.
Yes, I confirm