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Human Subjects Review Committee Proposal Form




Experimenter's Email Address:

Experimenter's Phone Number:

Institution(s) Affiliated:


Please include a brief description of the purpose of the study; if multiple studies are part of the proposal, describe the purpose of each.

Please describe your procedures exactly, including who your participants will be and how you will recruit them. If you are using any kind of questionnaire or survey, please attach your instrument(s).

Research in which a student is the principal investigator requires close faculty supervision.

Supervising faculty:

Date faculty completed IRB training:

How will close faculty supervision be accomplished in this study?


Procedures to Maintain Confidentiality and Anonymity:
Please detail exactly how you will maintain participant confidentiality - this is especially difficult on a small campus so please consider what you will do when the researcher may know the participant.

How long will data collection last?

Please describe the benefits provided by the study both to knowledge in general and particularly to the participants.

Please describe risks, both physical and psychological to the participants in your study. Make sure to consider age-specific risks, particularly when using minors as participants.


To complete the process for submitting your information, please send the following to Dr. Kathryn Hahn, hahnks@millsaps.edu:

**Please also attach:

  • your consent and debriefing forms
  • any instruments or measures you will use -the Primary Investigator (PI’s) and supervising faculty ethical training confirmation

Training found at https://phrp.nihtraining.com/users/login.php or through CITI training.