Human Participants Protection Committee Application_revised_2-12-08

Human Participants Protection Committee Application_revised_2-12-08

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ALLIANT INTERNATIONAL UNIVERSITY LOS ANGELES HUMAN PARTICIPANTS APPLICATION PACKET Effective: February 12, 2008
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ALLIANT INTERNATIONAL UNIVERSITY LOS ANGELES PART A APPLICATION TO HUMAN PARTICIPANTS PROTECTION COMMITTEE FOR APPROVAL OF RESEARCH AT AIU-LA Title of Research Project: Name(s) of Principal Investigator(s): Mailing Address: Program: Track: Course Instructor/Psy.D. Project Supervisor/Dissertation Chair (if principal investigator is student): Please identify which of the following you are applying for: ____ Non-Research Research Status (Complete Non-Research Form Only ) ____ Exempt Research Status (Complete Part B Section I and Parts C, D, E and F) ____ HPPC Expedited Review (Complete Part B Section II and Parts C, D, E and F) ____ Informed Consent Waiver (Complete Part B Section III and Parts C, D, E and F) ____ None of the above (Complete Parts C, D, E and F) Please check if any of the following subject groups are involved in your proposed research: ____Children (under 18) ____Prisoners ____Mentally Disabled ____Pregnant Women ____Institutionalized Groups Please check which of the following your study is being completed for: ____Faculty Research Project ____Staff Research Project
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____Research Practicum Project ____Psy.D. Project (Do not submit an HPPC application unless your project supervisor and consultant have reviewed and approved your proposed project . MAKE SURE TO SUBMIT A COPY OF YOUR SIGNED DOCTORAL PSYCHOLOGY PROJECT CONTRACT WITH THIS APPLICATION) ____Ph.D. Dissertation or Doctoral Research Project (Do not submit an HPPC application unless you have passed preliminary orals and you have received written approval from the appropriate Ph.D. Program Office . MAKE SURE TO SUBMIT A COPY OF YOUR SIGNED DOCTORAL DISSERTATION/ RESEARCH CONTRACT WITH THIS APPLICATION.) ____Organizational Psych Second Year Project ____Other (Specify:_________________________________________) AIU-LA requires that all original forms, surveys, code books, code sheets, consent forms and other documents that disclose the identity of participants in a study (the “Original Data”) be destroyed no later than five (5) years after the completion of the study. Identify below the month and year when you will [ Plan to? Or intend to?] destroy all Original Data. Month: ___________________ Year: The principal investigator assures the Human Participants Protection Committee (HPPC) that he/she has read the Alliant International University – Los Angeles Policies For Protecting Human Research Participants (the “Procedures”), that all data collection performed as part of this research will comply with the Procedures, that all research will be conducted by individuals qualified to do so, and that any change in the methods will be submitted to the HPPC for approval prior to implementation. ________________________________________________ __________ Signature of Principal Investigator
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Human Participants Protection Committee Application_revised_2-12-08

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