ࡱ>  @bjbj$$ 4fF|F| N ,,,,,@@@8xt@xS.&<<<- 9RRRRRRR$UXXR],AAAR,,<<2SC C C AF,<,<RC ARC C OXoR<zjGQ(RHS0xSoQXRXPoRX,oR,AAC AAAAARRC AAAxSAAAAXAAAAAAAAA : Interim Application For Continuing Research  updated 7/14  1. Project Identification and Signatures Project Title  FORMTEXT       Current Anticipated Duration of Your Research Project* (*Please note that for any project continuing for more than 12 months from your original IRB approval date, you will need to fill out this Interim Application for Continuing Research and for any project continuing for more than 24 months beyond your original IRB approval date, you will need to re-submit your IRB application as a new study to obtain a new approval.)  FORMTEXT       Research site? (Note: if this is external to St. Mary s, you need to provide updated written permission on official letterhead with original signature(s) from that site to recruit participants and to collect data.)  FORMTEXT        Responsible Faculty or Staff Investigator (Note: For student research projects, a faculty or staff member must agree to be the responsible investigator for the project.) Name (Last name, First name):  FORMTEXT      Department or School:  FORMTEXT      E-mail Address:  FORMTEXT      Phone Number:  FORMTEXT      Program Providing Funding:  FORMTEXT       As Responsible Investigator of this study, I assure the IRB that the following statements are true: I certify that the protocol accurately describes the research procedures and incorporates human subjects protections, including the assessment and management of potential risks and an appropriate informed consent process. To the best of my understanding, I believe the protocol meets the requirements of the Institutional Review Board and applicable regulations for protecting research subjects. I assume responsibility for 1) ensuring that any student researchers are aware of their responsibilities as investigators, and 2) that the IRB will be immediately informed in the event of research-related unanticipated risks or problems, or findings during the study that would affect the risks or benefits of participation.Investigator role:  FORMCHECKBOX Faculty  FORMCHECKBOX Staff  FORMCHECKBOX  Administrator  FORMCHECKBOX Other  FORMTEXT *0^nvxz    򾹱nVG9h1=hU<5CJ\aJh1=hU<CJOJQJ^J/jDhU<5CJOJQJU\^JaJ hU<5CJOJQJ\^JaJ)jhU<5CJOJQJU\^JaJhU<5CJ \aJ hU<CJ aJ hU<aJhU<hU<CJaJ hU<:h1=hU<CJaJhr}:CJOJQJaJhgUhU<:CJOJQJaJhhU<:OJQJhU<:CJ OJQJaJ xz|~ekd$$Ifl4a'`064 laf4 $IfgdU< $$Ifa$gdU<~ z $IfgdU<gdU< & FgdU<gdU<gdU<ekd$$Ifl4a' 064 laf4 " $ 9 :  $IfgdU<gdU< & FgdU<gdU<`kd$$Ifl`'&0&64 la  $  3 O S    6 8 9 : ; E F    . 0 2 ʿrd]S]hzhU<5] hU<5]h1=hU<5CJ\aJh1=hU<CJOJQJ^J/jBhU<5CJOJQJU\^JaJ hU<5CJOJQJ\^JaJ)jhU<5CJOJQJU\^JaJhU<5CJ \aJ hi hU<CJaJ hr}CJ hU<CJh-hU<CJhpnhU<CJaJhU< hU<6]    $IfgdU<gdU< & FgdU<gdU<`kd$$Ifl`'&0&64 la 2 `   H FHɺɋɺ~vkVE hU<5CJOJQJ\^JaJ)jhU<5CJOJQJU\^JaJh'a>hU<CJaJhU<CJ aJ hU<hU<5CJ\0jhU<5CJOJQJU\^JmHnHu+j@hU<5CJOJQJU\^JhU<5CJOJQJ\^J%jhU<5CJOJQJU\^Jh%hU<CJ aJ hU<5CJ]aJhzhU<5CJ]aJ FH $IfgdU< & FgdU<gdU<`kd$$Iflh&D%064 la$&:<>ҾҥҰaҥDҶҥ/<5CJOJQJU\^JaJ hU<5 hU<5CJ OJQJ\^JaJ 4jhU<5CJOJQJU\^JaJmHnHu/jhU<5CJOJQJU\^JaJ hU<5CJOJQJ\^JaJhU<CJaJ&h1=hU<5CJOJQJ\^JaJ)jhU<5CJOJQJU\^JaJ/j@hU<5CJOJQJU\^JaJ$Lj $IfgdU<vkd($$Ifs40C'4[0&64 sa'f4=ҷүҖ~ҷҧyeyZK?K?K?hU<CJOJQJaJhchU<CJOJQJaJhU<5CJ\aJ&hNLhU<5CJOJQJ\^JaJ hU<5/jhU<5CJOJQJU\^JaJ hU<5CJOJQJ\^JaJhU<CJaJhU<CJaJ4jhU<5CJOJQJU\^JaJmHnHu)jhU<5CJOJQJU\^JaJ/jmhU<5CJOJQJU\^JaJjaa $IfgdU<kdU$$Ifs4FC'\  [0&6    4 sa'f4p'ckd $$Ifs4C'&0&64 sa'f4 $IfgdU< $IfgdU<ckdY$$Ifs4C'&0&64 sa'f4=Y   !/01;<=ºxfT#jhU<CJOJQJU^JaJ#j hhU<CJUaJ#j hhU<CJUaJ#j+ hhU<CJUaJ#j hhU<CJUaJjhU<CJUaJhU<CJaJ hU<5h'a>hU<CJOJQJaJhkP%hU<CJOJQJaJhU<CJOJQJaJhchU<CJOJQJaJ;<66n6x6xx $IfgdU<ukd $$Ifs04C'0&64 sa' $IfgdU<=GH6 6 666x6z6~6 77*7,7.70767@7B7^7`7b7d7h7ɱ˪ygy[yyIy[#j@hhU<CJUaJh}hU<5CJaJ#j hhU<CJUaJh}hU<CJaJjh}hU<CJUaJ hU<5]hU< hU<5\ hU<5 hU<5CJ.jhU<CJOJQJU^JaJmHnHuU#jhU<CJOJQJU^JaJ)jq hU<CJOJQJU^JaJhU<CJOJQJ^JaJ     Original Signature of Responsible InvestigatorDate Have your research methods or materials for the study have changed?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, please explain:  FORMTEXT        Have your consent procedures changed?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, please explain:  FORMTEXT        Has your study population or sampling or recruiting methods changed?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, please explain:  FORMTEXT        Have any adverse or unanticipated ethical issues arisen over the course of the past year during your research?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, please explain:  FORMTEXT        ______________IRB use only_________________________________________________________________________ 1.9 Human Subjects Administration This section is to be completed by IRB staff or members only. APPROVED as  FORMCHECKBOX  Category 1 or  FORMCHECKBOX  Category 2 ResearchOriginal Signatures of one IRB member and the IRB chair Date Submit this application and appendices (if any) as one file via the Institutional Review Board (IRB) Application Moodle site.  You have reached the end of this form. Congratulations!     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