2024-2025 SRC/IRB MEMBERSHIP ROSTER

2024-2025 SRC/IRB MEMBERSHIP ROSTER

Please complete all applicable sections BEFORE submitting the form.

PLEASE BE AWARE OF THE NEW TRAINING REQUIREMENT FOR EACH SRC-IRB COMMITTEE CHAIR (see below in form).

All members are strongly encouraged to complete the online, self-paced training which is FREE to everyone, but short of that, the Chair is responsible for ensuring all members are appropriately trained, briefed, and provided the current ISEF Rules for Pre-College Research either electronically (PDF) or hard copy.

As a reminder:

IRB Committees require the following minimum members:

Educator
School Administrator
Medical and/or Mental Health Professional

SRC Committees require the following minimum members:

Biomedical Scientist
Educator
Additional member

Combined SRC/IRB Committees require the following minimum members:

Biomedical Scientist
Educator
School Administrator
Medical and/or Mental Health Professional

IF YOU HAVE QUESTIONS OR REQUIRE CLARIFICATION, PLEASE EMAIL scifair@unm.edu.

SCHOOL INFORMATION

SCHOOL NAME*

Please spell out the school name as well as the words "Elementary School", "Middle School", or "High School".

SCHOOL STREET ADDRESS*

Please ensure the street address is typed out using capital letters in the appropriate places!

SCHOOL CITY*

Please ensure the city name is spelled correctly and begins with a capital letter.

SCHOOL STATE*

Please use the 2-letter state abbreviation.

SCHOOL ZIP CODE*

TYPE OF REVIEW COMMITTEE

TYPE OF REVIEW COMMITTEE*

Please choose the type of committee you will be fielding (SRC, IRB, or COMBINED).

SRC's review all types of projects EXCEPT those involving human participants.

IRB's review projects involving human participants.

REMEMBER... if you field a combined committee, you MUST have at least the minimum number of members with the required expertise noted in the ISEF rules.

Scientific Review Committee (SRC)

Institutional Review Board (IRB)

COMBINED COMMITTEE (SRC-IRB)

REVIEW COMMITTEE CHAIR INFORMATION

Who have you designated as the Chair of your review committee?

The Chairperson MUST also be fully listed in the SRC or IRB/COMBINED members section below!

CHAIRPERSON LAST NAME*

CHAIRPERSON FIRST NAME*

CHAIRPERSON EMAIL*

CHAIRPERSON CELL PHONE*

Phone

REQUIRED TRAINING ACKNOWLEDGEMENT

This is the SRC-IRB Chairperson's acknowledgement that the online training module has been completed. Once completion is confirmed, the Contact Person and Chairperson will be notified of the approval for this committee to conduct prior approval and pre-competition reviews.

REMEMBER...All vertebrate animal projects in Central NM MUST be reviewed for prior approval by the Central NM Regional SRC-IRB Committee.

We strongly recommend local committees conduct final pre-competition reviews of all projects to be sure all rules and processes were followed.

IF "NO" IS CHECKED, YOU DO NOT NEED TO CONTINUE COMPLETING THIS FORM AS YOUR COMMITTEE WILL NOT BE APPROVED TO CONDUCT PRIOR APPROVAL REVIEWS!

YES - I understand and agree to abide by the Required Training Acknowledgement

NO - I do not agree to abide by the Required Training Acknowledgement.

SRC-IRB TRAINING CONFIRMATION (Date Completed by COMMITTEE CHAIR)*

Beginning in the 2024-2025 school year, the SRC-IRB Chairperson is REQUIRED to complete the new Online SRC-IRB Committee Training Module.

NOTE: All committee members are strongly encouraged to also complete the training. Short of that, each committee's Chairperson is required to ensure all committee members are briefed re: their role, review processes, ISEF rules/forms, etc. and are provided with a link to the current year's ISEF Rules for Pre-College Research OR a hard copy of the document BEFORE any projects are reviewed.

The date provided below should be when your SRC-IRB Committee Chairperson completed the online training. This will be confirmed by STEM-H Center staff.

PRIMARY CONTACT PERSON INFORMATION

Who should we contact first if there are questions regarding your review committee?

CONTACT PERSON FIRST NAME*

CONTACT PERSON LAST NAME*

CONTACT PERSON TITLE*

CONTACT PERSON EMAIL*

CONTACT PERSON CELL PHONE*

Phone

SCIENTIFIC REVIEW COMMITTEE MEMBERS

BIOMEDICAL SCIENTIST FIRST NAME*

BIOMEDICAL SCIENTIST LAST NAME*

BIOMEDICAL SCIENTIST TITLE*

BIOMEDICAL SCIENTIST EMAIL*

BIOMEDICAL SCIENTIST DEGREE(s)*

Please choose all applicable completed degrees. This member MUST have a graduate level degree.

Select

BIOMEDICAL SCIENTIST ACADEMIC MAJOR(s)*

Please provide the academic major for each completed degree.

EDUCATOR FIRST NAME*

EDUCATOR LAST NAME*

EDUCATOR EMAIL*

EDUCATOR DEGREE(s)*

Please choose all applicable completed degrees.

Select

EDUCATOR ACADEMIC MAJOR(s)*

Please provide the academic major for each completed degree.

ADDITIONAL SRC MEMBER FIRST NAME*

ADDITIONAL SRC MEMBER LAST NAME*

ADDITIONAL SRC MEMBER EMAIL*

ADDITIONAL SRC MEMBER DEGREE(s)*

Please choose all applicable completed degrees.

Select

ADDITIONAL SRC MEMBER ACADEMIC MAJOR(s)*

Please provide the academic major for each completed degree.

IRB/COMBINED COMMITTEE MEMBERS

IRB/COMBINED SCHOOL ADMIN FIRST NAME*

IRB/COMBINED SCHOOL ADMIN LAST NAME*

IRB/COMBINED SCHOOL ADMIN EMAIL*

IRB/COMBINED SCHOOL ADMIN DEGREE(s)*

Please choose all applicable completed degrees.

Select

IRB/COMBINED SCHOOL ADMIN ACADEMIC MAJOR(s)*

Please provide the academic major for each completed degree.

IRB/COMBINED EDUCATOR FIRST NAME*

IRB/COMBINED EDUCATOR LAST NAME*

IRB/COMBINED EDUCATOR EMAIL

IRB/COMBINED EDUCATOR DEGREE(s)*

Please choose all applicable completed degrees.

Select

IRB/COMBINED EDUCATOR ACADEMIC MAJOR(s)*

Please provide the academic major for each completed degree.

IRB/COMBINED MEDICAL-MH FIRST NAME*

IRB/COMBINED MEDICAL-MH LAST NAME*

IRB/COMBINED MEDICAL-MH EMAIL*

IRB/COMBINED MEDICAL-MH DEGREE(s)*

Please choose all applicable completed degrees.

Select

IRB/COMBINED MEDICAL-MH ACADEMIC MAJOR(s)*

Please provide the academic major for each completed degree.

LIST ADDITIONAL COMMITTEE MEMBERS

Please list any additional SRC-IRB Committee members (ex: subject matter experts who review certain types of projects, etc.). Include full name, degree(s), and an email address for each person listed below. If NONE, please type NONE into the box.

FILE UPLOAD

If you have additional members not listed above, please attach a PDF document that lists those individuals along with the same information provided for all other review committee members.

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