IRB APPLICATION SUBMISSION PORTAL

Lucas Sieburg, M.S. Chair PH 402-552-6133 or 773-569-1123

IRB@clarksoncollege.edu

CONTACT INFORMATION

Submission Date*

Principal Investigator (PI) Name*

The PI is the person ultimately responsible for the project.

PI Email*

PI Email

PI Phone Number*

PI 10-Digit Number

PI Status*

Select

PI Other Status

Co-Investigator (CI) Name (Students this will be your Faculty Advisor)*

Please enter the CI Full Name if applicable here.

Select or enter value

CI Email

CI Phone Number

CI 10-Digit Number

Select

CI Status*

Select

CI Other Status

STUDY/PROJECT INFORMATION

Title of Study/Project*

PI's Role or Status at Study Site*

Type of Review*

Select

APPLICATION & SUPPORTING DOCUMENTATION

IRB Application Site Approval Letter Informed Consent Forms Data Collection Instrument (e.g., survey or interview questions, pre/post test documents) CITI Certification Documents must be submitted separately with specific file name. (LastName.FirstName.DocumentTitle)

File Upload- Application; Supporting Appendix Documents (e.g., CITI Certificates, Consent Forms)*

These will files must be uploaded individually with specific file naming.

Drag and drop files here or

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