Research Compliance Consolidated Cover Page Georgia Southern University
For electronic submission: Your proposal narrative should already be completed and saved. Next complete cover page and “Save As” a word document to your computer or disk named “Coverpage_Year_Month_Date_lastname, First initial.doc”. Then open and complete Informed Consent Checklist. Email the entire package to IRB@georgiasouthern.edu. Original signature pages may follow by mail.
Application for Research Approval
Investigator Information:
Name of Principal Investigator: Phone: Email: Address: For Office Use Only: Protocol ID: ___________ Date Received: Department: Name(s) of Co-Investigators: Title of Co-Investigator(s):
Personnel and/or Institutions Outside of Georgia Southern University involved in this research:
Project Information:
Title: Brief (less than 50 words) Project Summary:
Compliance Information:
Please indicate which of the following will be used in your research:
Human Subjects (IRB Approval Number) Care and Use of Vertebrate Animals (IACUC Approval Number) Biohazards only Project Start Date:
Biosafety Level: Exempt BSL 1 BSL 2
Signature of Applicant (Faculty ONLY):
Project End Date:
(no more than 3 years)
Please indicate if the following are included in the study: Use of rDNA Last EHS lab safety inspection date: ________________________ Last IBC biosafety lab inspection date: ________________________ Date:
X Please submit this protocol to the Georgia Southern University Compliance Office, c/o The Office of Research Services & Sponsored Programs, P.O. Box 8005. The application should contain all required documents specific to the committee to which you are applying. Questions or comments can be directed to (912) 478-5465 or IRB@georgiasouthern.edu Consolidated Application Cover Page