IAA Tracking

IAA Tracking

Requester's Name*

Requester Email*

IRB to hold approval*

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Collaborating Institution IRB

UNT IRB #

Collaborating Site IRB #:

Review Level*

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Collaborating Institution IRB Contact Email*

Project Title*

UNT PI Email:*

UNT PI Name:*

UNT Staff to Work on Project*

Please briefly describe the UNT staff role*

Collaborating PI Name at External Institution:*

Collaborating Institution PI Email:*

Collaborating Site Staff to Work on Project*

Briefly describe the Collaborating staff role*

Copy of External Consent:

Copy of External Protocol:

Copy of External Approval Letter:

File Upload

Please upload the Informed Consent document, Protocol, and Approval Letter in the space provided below

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Funding Source*

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Name of Funding Agency

Any Additional Information?

Signature of Requester

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