VPR


VPR Home	VPR Staff \| Faculty Expertise \| Events \| Publications

Human Research Protection Program
Ernest C. Young Hall
10th Floor, Room 1032
155 S. Grant Street
West Lafayette, IN 47907-2114
Phone: 49-45942
Fax: 49-49911
irb@purdue.edu

Forms

Download the latest version Adobe Reader in order to view the forms

NEW Exemption Request Forms	PDF Document	Word Document
Category 1
Research conducted in educational settings, involving normal educational practices
Guidelines to determine eligibility
Category 1 description
Category 2
Research involving the use of educational tests, survey procedures, interview procedures or observation of public behavior
Category 2 description
Category 3
Research using category 2 study procedures that is not exempt under Category 2 IF: (see Category 3 description)
Category 3 description
Category 4
Research involving the collection or study of existing data, documents, records, pathological or diagnostic specimens
Category 4 description
Category 5
Research and demonstration projects on public benefits and service programs (NOTE: This category applies only to activities conducted pursuant to a federal statutory authority). If you feel your research meets the criteria for category 5, please contact the IRB Administrator
Category 5 description
Category 6
Taste and food quality evaluation and consumer acceptance studies
Category 6 description

Reviewed Research Application Forms -In .pdf format use the Tab key to navigate through the fields -Add additional pages if more space is required	PDF Document	Word Document
Application Form - NEW
Revision of Protocol Form - NEW

Consent/Assent Templates -The Consent Form and Assent Form include special instructions in orange italics -Replace italics on form as needed (Tab key will not navigate through fields)	PDF Document	Word Document
Consent Form (template only) - NEW
Consent Form Instructions- NEW
Sample Assent Form

Unanticipated Problem/Adverse Event Reporting	PDF Document	Word Document
Reporting Form
Decision Tree

HIPAA Forms	PDF Document	Word Document
Authorization for Release of PHI (Non-Purdue Covered Entities)
Authorization for Release of PHI (Purdue Components)
Request for Waiver of Authorization or Modification of Authorization
Activities Preparatory to Research Waiver
Use of Decendent's Information Certification
Data Use Agreement

Checklist for IRB Submissions -Investigators have developed these Research Tracking Forms which we have posted for your convenience -If you find these forms helpful, use them.	PDF Document	Word Document
Research Group Management Checklist
Subjects Management Checklist

Miscellaneous Forms	PDF Document	Word Document
Participant Payment Disclosure Form