ࡱ> @B? Hbjbj :2xxH    D "8aaaaa<<<"""""""$$&&"<<"aa"iii aa"i"iiR !a:  !{""0"!''<!'!<:i.*<<<""<<<"'<<<<<<<<< : TENNESSEE STATE UNIVERSITY HUMAN SUBJECTS COMMITTEE RESEARCH PROPOSAL FORM __________________________________________________________________________________________________________________________________________________________________________________________________ This proposal is: (check where applicable) Dissertation Research: ________________ Grant Proposal: _____________ Funding Agency: _________ Master's Thesis Research: ______________ Faculty Research: ____________ Undergraduate Research: ______________ Other: ______________________ __________________________________________________________________________________________________________________________________________________________________________________________________ IDENTIFICATION INFORMATION: (Complete all items. Use "N/A" if necessary). Title of Proposal: _________________________________________________________________________ ________________________________________________________________________ 2. Date: _____________________________ 3. Principal Researcher: ________________________________ E-mail Address: _____________________ Department: ____________________ 4. Campus Address: _____________________________________ _____________________________________ _____________________________________ Telephone Number: _______________________________ Other Researchers: ________________________________ Faculty Advisor (if applicable): ______________________________ E-mail- Address:____________________ Former Title of Proposal (if applicable): ______________________ Identify any other previous committee reviews, dates and results: ____________________________________ _____________________________________________________________________________________________ 10. This proposal is: ____ New ____An Amendment Yearly Progress Report for Previously Approved Project (only include proposed changes. Sub-Study Under an Umbrella (e.g. Research Center, Training, Grant, etc) Revised 25 Sep 2007 TENNESSEE STATE UNIVERSITY RESEARCH PROPOSAL NON-EXEMPT FORM BRIEF DESCRIPTION OF PROGRAM Research Plan Scientific rationales: Specific objectives: Describe types, numbers, age and sources of subjects to be studied. (From where will the subjects be recruited? How will subjects be recruited)? Identify all procedures that will be carried out with each type of subject in chronological order. Attach copies of tests or instruments to be used, and consent forms. IV. Does the project offer a direct benefit to each type of subject? (it need not) ______ yes ________no. If yes describe. V. Describe anticipated risks, discomforts, or inconveniences that might be associated with the procedures (that are beyond what subjects typically encounter in everyday life). VI. What precautions will be taken in those procedures where potential risk may be involved? VII. What steps will be taken for maintaining the subjects' confidentiality, rights, privacy, and well being? Include plans for maintaining confidentiality of documents and data, and access to such. VIII. Is any element of deception of the subjects necessary for this research?" _____ yes ______ no. If answer is "Yes" describe the nature of the deception and the procedure to counteract (undo) the deception. IX. Procedure for obtaining the participants' informed consent: Written consent form will be used _________ An oral presentation will be made _________ Other ________________________________ Regardless of the method chosen, the researcher must attach to this proposal the completed consent form or a description of the alternate procedure. If no consent is considered necessary, please explain. X. If other institutions are involved in any way in this research sponsored by Tennessee ӰԺַ, submit letters of cooperation form the administrative authority in these institutions. XI. The researcher agrees to seek prior approval form the committee for any changes in title, experimental procedures, informed consent procedures or working of informed consent letter, or other aspects of this proposal. The research further agrees to notify the committee immediately of any adverse effects experienced by subjects participating in this study. SIGNATURES: _____________________________________________________ Principal Researcher Date _____________________________________________________ Faculty Advisor (if applicable) Date ____________________________________________________ Department Chairperson Date ____________________________________________________ IRB Chair or Reviewer Date NOTE: Return completed Proposal Form and all attachments to: The Office of Research and Sponsored Programs Pick up approved forms from: Office of Research and Sponsored Programs, Research and Sponsored Programs Building, Suite 1A, Tennessee ӰԺַ, Box 9519, 3500 John A. Merritt Boulevard, Nashville, Tennessee 37209-1561 __________________________________________________________ VP for Research and Sponsored Programs Date 6M . % ' J ` c w x LM   ȹȹȹȹșȆs`sM$hh+ 5B*CJOJQJph$hBh)5B*CJOJQJph$hBhB5B*CJOJQJph$hBh+ 5B*CJOJQJph hBh+ 5B*OJQJphhBh5B*CJphhBh5B*CJphhBh+ 5B*CJphhBh+ 5>*B*CJphhBh+ 5CJ h+ 5h+ 5B*ph56MN < = . = > ?   y z p^p & F $a$z   : ; m n PQM^h^h & F   /0RSTqr & F  & F $a$gdp$a$^/0RTqZ^8D!-#0:BDlnw !.8@Hܼܸܴܴܴܭܧ܋܇܇h$sh2lm h2lmCJ h$sCJ h+ CJ h?'CJ h+ CJ h+ 56hhwShCh+ 56CJh+ 56CJh+ 5B*phh+ hp h+ 5hh+ 5hh+ 5B*CJph,RSTUVWXYZ & F & F ^   _CDEFGHIJKLM 0^`0z{|}~YZ[ & F 0^`0k !-./e45 0^`0 p0^p`05jHgdZ 8P:pS/ =!"#$% Dp^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalOJQJ_HmH sH tH DA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List 0U 0 Hyperlink>*B*PK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] H2Hz 5H8@0(  B S  ?\g4)\g>(\g *\g *\gt)\g,*\gT\gT *\g(\g$\g$\gZ(\gZ(\gd+\g+\gG(\g\G(\gG(\g2(\g2(\g,3(\g|:(\g:(\g:(\g"\g$"\gd"\g)\g$)\gd)]g$`( $>>HNQ[dnnxxJ      #..GMXXZclsvJ    9*urn:schemas-microsoft-com:office:smarttagsplace8*urn:schemas-microsoft-com:office:smarttagsCity9*urn:schemas-microsoft-com:office:smarttagsState; *urn:schemas-microsoft-com:office:smarttagsaddress=*urn:schemas-microsoft-com:office:smarttags PlaceName=*urn:schemas-microsoft-com:office:smarttags PlaceType: *urn:schemas-microsoft-com:office:smarttagsStreet>*urn:schemas-microsoft-com:office:smarttags PostalCode p3(  JJ?;rr P !/J`crr  U U       & & Z ^ F F } } 8 D vw J mLd`}8zf'-F8 94bC^?'2G3yj0`m[rBo#.vw@5. yn\vYC}jp0p^p`0o(.0^`0o(.0^`0o(.hh^h`o(.0^`0o(.^`o(.0^`0o(.p0p^p`0o(.p0p^p`0o(.p0p^p`0o(.p0p^p`0o()0^`0o(. -F85. ym`mBoYC}.vwC^?yj2G`}8 9 '&u$+ ZJ.!]t-i;o;S2lm$s&1|MZS)TB?'`n%DoBC:LbwSu|pf<>~1HJ@Hp@UnknownG* Times New Roman5Symbol3. * Arial?= * Courier NewA BCambria Math"h$ G$ GB $B $!r4>>3QHP?2!xx_THE COMMITTEE FOR THE PROTECTION OF RIGHTS AND WELFARE HAVE HUMAN SUBJECTS INVOLVED IN RESEARCHPreferred Customer Rebbecca Lowe<         Oh+'0 (4Xh    `THE COMMITTEE FOR THE PROTECTION OF RIGHTS AND WELFARE HAVE HUMAN SUBJECTS INVOLVED IN RESEARCHPreferred CustomerALT-F11 says it's groovie!NormalRebbecca Lowe2Microsoft Office Word@Ik@%.@%.B՜.+,0` hp  @Dell Computer Corporation$ > `THE COMMITTEE FOR THE PROTECTION OF RIGHTS AND WELFARE HAVE HUMAN SUBJECTS INVOLVED IN RESEARCH Title  !"#$%&'()*+,-.012345689:;<=>ARoot Entry F:C1Table((WordDocument:2SummaryInformation(/DocumentSummaryInformation87CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q