IRB Forms

Forms* (see Submission Instructions below 10-27-08) 

If you have any questions about which forms to complete, contact the Compliance Office staff for help. Electronic submission is required for all forms as Word documents. Please send all submissions to IRB@uml.edu  The PI Signature and Assurance page can be submitted by fax to x3018, scanned and e-mailed to the above e-mail address, or sent by intercampus mail. If your project involves payments/incentives to human subjects, please see the guidelines provided on the IRB Policies and Procedures page. 

Note: After you have a protocol number, please use it on all correspondence.  Do not send forms in PDF format. 

For Exempt Status Review, complete the Application for Exempt Status (doc) Determination, rev 8-15-08.

For Expedited or Full Review, read the Project Application Review Form Instructions (pdf) and then complete the appropriate form(s). Submit forms by e-mail to IRB@uml.edu:

• Project Application Review Form (doc) rev11-13-09 (includes PI Signature Pg)    
• PI Assurance and Signature Page (doc) rev 10-24-08
• Informed Consent Form (doc) rev 8-15-08  (This may be modified for your purposes. A signed copy will be returned to you after approval for your research.)
• Certification of Translation Form (doc) rev 6-25-09
• Collaborating Institution Authorization Agreement (doc) rev 2-20-08
• Individual Agreement Authorization Form (doc) 8-15-08
• Sample Assent Form (doc) rev 8-22-07
• Video/Photo Publication Release Form (doc) 10-24-08 This form is for publication of images collected during human subject research but could also be used for other purposes.

For Projects that have already received IRB approval, the following forms are provided: 

• Amendment Form (doc) rev 9-3-09
• Final Report Form (doc) rev 10-24-08
• Annual/Continuing Review Form (doc) rev 9-28-09
• Approval Renewal Form (doc) rev 5-25-07(for submission of a previously approved project to a different source of funding)
• Administrative Oversight Report Form (doc) 9-12-08
• Self-Report of Noncompliance by PI Form (doc) 9-3-09

Sample Informed Consent Forms are provided here as examples:

• Nanotechnology's Impact on Health Professionals (pdf)
• The Effects of Movement on On-Task Behavior in Elementary Music Classrooms, ver 1 (pdf)  
• The Effects of Movement on On-Task Behavior in Elementary Music Classrooms, ver 2 (pdf)      

For IRB Member Reviews, forms are available to document your review. These include: 

• Exempt Status Review Approval Form (doc) rev 7-12-07
• Expedited Review Approval Form (doc) rev 8-15-08
• Full Review Approval Form (doc) rev 7-12-07
• Amendment Approval Form (doc) rev 2-25-09
• Annual/Continuing Review Approval Form (doc) rev 7-12-07

New Submission Instructions

 Use IRB@uml.edu for all IRB application submissions and correspondence regarding applications.  

IRB application materials, especially those with multiple files, may be submitted using the UMass Lowell Dropbox tool at http://dropbox.uml.edu.  Enter your email credentials to log in and upload your folder/files to the dropbox and name them with your surname followed by a title that will help us to easily identify it. Send the notification that you have submitted files using the dropbox to IRB@uml.edu. 

For more information, go to Information Technology.

Thank you, and if you have any questions, please call Elaine Major at ext. 3452.