WPC  }Pg; t!ُ ; 7:&+TSp $!W#ss:}у%d2NrK (o,hU֤y~tGԗ_=Ռi[qW_x(&7X櫑fΎZYӇ=UвloaCФ肌V0-#e4\į!ꄈqL|1Wiy55C Zw9ЦEzmLK=m[=BC\o`5#[};BFXSPk/e',݇9%I3}@JD3}`Q(Q+̕}/Jpz6YQmRfjI`?$\;Ory M>I|z]al?fY&!ʇrtr. #utFAWŭ-C hdU@x %- 0[EF UHH UN C f a B  + nX; 0@ B  nX ^ H 4T 0\h  N  w( m #  1] 1uu 0cUNMUNNUN 729 72kU@N 0hGU@ B* B*      0\7 D5 0\ AS$w 0D=) `(CG TimesScalable  # '   _   ! f   _RSSP_ԀProjectNumber#   ! fk# ?' ` dE ` ?(32$ !     +_ 0CG TimesBoldScalable(^ Z 6Times New Roman Regular dTable_AK Kd3|h) `(CG TimesScalable  h P7 P+_ 0CG TimesBoldScalable_ p^7($     d) `(CG TimesScalable  h P7 P+_ 0CG TimesBoldScalable_ p^72 d}0_XX(43H$ !     H?EEUAdobe PDF,,,,0(5hCEKQW]cioAutoList11.1.1.1.1.1.1.1. ##37=CIQYag1.a.i.(1)(a)(i)1)a)(;3$2#  0  .3  0  (^ Z 6Times New Roman Regular(^ Z 6Times New Roman Regular(^ Z 6Times New Roman Regulari)i)(4 Z(Times New Roman (@3ȁ$ !      d  H)   _@RRR  1  ڀ  @Level 1Level 2Level 3Level 4Level 5(4 Z(Times New Roman &0 d d&P d d(43H$ !     )!dxdx(43H$ !     b_]c^E<<CLevel 1Level 2Level 3Level 4Level 5($$   1  !     _  XXX'%  d     `     h       Z@   lZ&%lUNIVERSITYOFARKANSAS #&K %%&##Z %&K#ԀlZll f l&%  f INSTITUTIONALREVIEWBOARD   @+@@+ PROTOCOLFORM    Ѐ$XXX$# f %&}#  # f   f?#XX,   f+  ,TheUniversityInstitutionalReviewBoardrecommendspoliciesandmonitorstheirimplementation,ontheuseof  humanbeingsassubjectsforphysical,mental,andsocialexperimentation,inandoutofclass....Protocolsfortheuseofhumansubjectsinresearchandinclassexperiments,whetherfundedinternallyorexternally,mustbeapprovedbythe(_IRB_)orinaccordancewith_IRB_Ԁpoliciesandprocedurespriortotheimplementationofthehumansubjectprotocol...ViolationofproceduresandapprovedprotocolscanresultinthelossoffundingfromthesponsoringagencyortheUniversityofArkansasandmaybeinterpretedasscientificmisconduct.#,  +## f  ,#Ԁ(seeFacultyHandbook)   XX%%\%Supplytheinformationrequestedinitems114asappropriate. Type entriesinthespacesprovidedusingadditionalpagesasneeded. : F  Inaccordancewithcollege/departmentalpolicy,submittheoriginal and onecopyofthiscompletedprotocolformandallattached    materialsto f   fԀthe# f   f#appropriate f   fHumanSubjectsCommittee.Intheabsenceofan_IRB_ԄauthorizedHumanSubjectsCommittee,# f   fM #submit   theoriginal and onecopyofthiscompletedprotocolformandallattachedmaterials f   fԀtothe# f   f #_IRB_,Attn:CompolianceOfficerCynthiaSharp,_OZAR_   118,57538452208. f   fԀ   jj1.0  TitleofProject?'H8dEH8? %% 0XXXX00  ?'H8dEH8?%% jj2.0  6XX4DXX6(Students must haveafacultymembersupervisetheresearch.Thefacultymembermustsignthisformandallresearchersand o{ thefacultyadvisorshouldprovideacampusphonenumber.) %% 6X,X DXX46   NameDepartmentEmailAddressCampusPhone  PrincipalResearcher򀀀  6X,X DX,X 6  CoResearcher򀀀 !- 9X,X DX,X 9  CoResearcher 򀀀    CoResearcher򀀀 am  Ѐ  FacultyAdvisor򀀀  " 3.  Researcher(s)status.Checkallthatapply. q!}%   %Faculty%Staff%GraduateStudent(s)%UndergraduateStudent(s) #' Ѐjj4.0  Projecttype$ )%% ?X,X DX,X ?  %FacultyResearch0 0 % %# f   f # f   f%# f   f# f   fԀThesis/Dissertation# f   f$#0D % %% f   fClassProject# f   f#0D%D% f   f%IndependentStudy/# f   f#Q&]"+%%   %StaffResearch0 0 % % f   f%# f   f# f   fԀM.A.T.Research# f   f #0D % % f   f%HonorsProject# f   fp#0D%D%Educ.Spec.Project!'-#,%%    f   f# f   f-#jj5.0  Istheprojectreceivingextramuralfunding?($.%%   %No%Yes.Specifythesourceoffunds?'%ydE*y? a*m&0   , (2 d    6.0  Briefdescriptionofthepurposeofproposedresearchandallproceduresinvolvingpeople.Bespecific.Useadditionalpages X ifneeded.( Donot sendthesisordissertationproposals.Proposalsforextramuralfundingmustbesubmittedinfull.)(%%   Purposeofresearch:  Proceduresinvolvingpeople:jj7.  Estimatednumberofparticipants(completeallthatapply) J   <XX4DX,X D<&  4p,b,,X%X%4  _____Childrenunder14' .   @ _____Children1417   @3v______UA_Ԁstudents3  (18yrsandolder)  b  @F!_____Adultnonstudents  b  4p,b,,X X 46XX4DXX46jj8.0  Anticipateddatesforcontactwithparticipants:Z %% @10  FirstContactA)` dE` Appp  LastContact?'u` dEu` ?%% jj9.0  InformedConsentprocedures:Thefollowinginformationmustbeincludedinanyprocedure:identificationofresearcher, B institutionalaffiliationandcontactinformation;identificationofComplianceOfficerandcontactinformation;purposeoftheresearch f   f,# f   f"# f   fԀexpecteddurationofthesubject'sparticipation;descriptionofprocedures;risksand/orbenefits;howconfidentiality : willbeensured;thatparticipationisvoluntaryandthatrefusaltoparticipatewillinvolvenopenaltyorlossofbenefitstowhichthesubjectisotherwiseentitled.# f   f<## f   fSeePoliciesandProceduresGoverningResearchwithHumanSubjects,section5.0  RequirementsforConsent# f   f$# f   f.R%%   %Signedinformedconsentwillbeobtained. Attachcopyofform . J   %Modifiedinformedconsentwillbeobtained# f   fy%#. Attachcopyofform .    %Othermethod(e.g.,impliedconsent f   f). Pleaseexplainonattachedsheet .    %Notapplicabletothisproject# f   f"'#. Pleaseexplainonattachedsheet . h 10.0  ConfidentialityofData:Alldatacollectedthatcanbeassociatedwithasubject/respondentmustremainconfidential.Describe b  themethodstobeusedtoensuretheconfidentialityofdataobtained. %% 9X,Xr4DXX4911.0  Risksand/orBenefits:$*")%%   Risks:0 r Willparticipantsintheresearchbeexposedtomorethanminimalrisk? f   f%# f   fR*#ԀYes f   f%# f   f*#ԀNoMinimalriskisdefined R%"* asrisksofharmnotgreater,consideringprobabilityandmagnitude,thanthoseordinarilyencounteredindailylifeorduringtheperformanceofroutinephysicalorpsychologicalexaminationsortests.Describeanysuchrisksordiscomfortsassociatedwiththestudyandprecautionsthatwillbetakentominimizethem. r%r%    r  4    r   Benefits:0 r Otherthanthecontributionofnewknowledge,describethebenefitsofthisresearch.+z)2r%r%    /-7 12.0  Checkallofthefollowingthatapplytotheproposedresearch.Supplythe f   frequested# f   f$.# f   fԀinformationbeloworonattachedsheets:X%% <XX(4DX,Xr4<  %|| (A.0  Deceptionoforwithholdinginformationfromparticipants.Justifytheuseofdeceptionorthewithholdingof  information.Describethedebriefingprocedure:howandwhenwillthesubjectbeinformedofthedeceptionand/ortheinformationwithheld? %%   % (B.0  Medicalclearancenecessarypriortoparticipation.Describetheproceduresandnotethesafetyprecautionstobetaken.h%%   % (C.0  Samples(blood,tissue,etc.)fromparticipants.Describetheproceduresandnotethesafetyprecautionstobetaken.8%%   %|| (D.0  Administrationofsubstances(foods,drugs,etc.)toparticipants.Describetheproceduresandnotethesafety  precautionstobetaken. %%   % (E.  Physicalexerciseorconditioningforsubjects.Describetheproceduresandnotethesafetyprecautionstobetaken.  P    % (F.0  Researchinvolvingchildren.Howwillinformedconsentfromparentsorlegallyauthorizedrepresentativesaswellas x   fromsubjectsbeobtained? %% 0  %|| (G.0%%Researchinvolvingpregnantwomenorfetuses.Howwillinformedconsentbeobtainedfrombothparentsofthefetus? %% 0  %|| (H.0%%Researchinvolvingparticipantsininstitutions(cognitiveimpairments,prisoners,etc.).Specifyagenciesorinstitutions   involved.Attachlettersofapproval.Lettersmustbeonletterheadwithoriginalsignature;electronictransmissionisacceptable. %%   % (I.0  Researchapprovedbyan_IRB_Ԁatanotherinstitution.Specifyagenciesorinstitutionsinvolved.Attachlettersof X  approval.# f   fo.# f   fLettersmustbeonletterheadwithoriginalsignature;electronictransmissionisacceptable.( %% # f   f7# f   f  % (J.0  Researchthatmustbeapprovedbyanotherinstitutionoragency.Specifyagenciesorinstitutionsinvolved.Attach  lettersofapproval.# f   f|8#Lettersmustbeonletterheadwithoriginalsignature;electronictransmissionisacceptable.p%% <XX4DXX(4<13.0  ChecklistforAttachmentsh%% BX X}4DXX4B* ddd Xdd Xdd XX%X%,(# +  5 "  50  Thefollowingareattached: X E-s$$    HxX0  %0$$Consentform(ifapplicable)or X E-$$ x H   xX0  %0$$Lettertoparticipants,writteninstructions,and/orscriptoforalprotocolsindicatingclearlytheinformationinitem#9. X E-[$$ x    HxX0  %0$$Letter(s)ofapprovalfromcooperatinginstitution(s)and/orother_IRB_Ԁapprovals(ifapplicable) X E-K$$ x H   xKX0  %0$$Datacollectioninstruments=31$$ xK     =    14.0  SignaturesN%% 0  0%%I/weagreetoprovidethepropersurveillanceofthisprojecttoinsurethattherightsandwelfareofthehumansubjects/respondentsareprotected.I/wewillreportanyadversereactionstothecommittee.Additionstoorchangesinresearchproceduresaftertheprojecthasbeenapprovedwillbesubmittedtothecommitteeforreview.I/weagreetorequestrenewalofapprovalforanyprojectwhensubject/respondentcontactcontinuesmorethanoneyear. %% BXX4DxXX4B  PrincipalResearcher򀀀 x Date򀀀 V# %   CoResearcher򀀀 x Date򀀀 $"'   CoResearcher򀀀 x Date򀀀 &>$)   CoResearcher򀀀 x Date򀀀 6(%+   FacultyAdvisor򀀀 x Date򀀀 )~'-      4  D  x  v+)/ XXXX   $ f   f$X/X $ fPROTOCOLAPPROVALFORM#$ f X$X/G#   G  $,  $ f@,,(Tobereturnedto_IRB_ԀProgramManagerwithcopyofcompletedprotocolformandattachments)  iHAX) xdEeP A fx  HumanSubjectsCommitteeUseOnly (Inabsenceof_IRB_ԄauthorizedHumanSubjectsCommittee,sendprotocolto_IRB_.) {   RecommendedReviewStatus    vJHumanSubjectsCommitteecanapproveasexemptbecausethisresearchfitsinthefollowingcategoryofresearchasdescribed    insection9.02ofthe_IRB_Ԁpoliciesandprocedures (Citereasonsforexemptstatus.) : [ m  򀀀 % 7  򀀀    PrintedNameand   Signatureofthe_HSC_ԀChair򀀀Date򀀀 w  ******************************************************************************************************ExpeditedReviewbyadesignatedmemberofthe_IRB_Ԁbecausethisresearchfitsinthefollowingcategoryofresearchas   describedinsection9.03ofthe_IRB_Ԁpoliciesandprocedures (Citereasonsforexpeditedstatus.) :   򀀀 Yk 򀀀 1 PrintedNameand  E ,` pLXX4D4ESignatureofthe_HSC_ԀChair򀀀Date򀀀  ******************************************************************************************************* 7I RequiresFullReviewbythe_IRB_Ԁbecausethisresearchfitsinthefollowingcategoryofresearchasdescribedinsection9.04  ofthe_IRB_Ԁpoliciesandprocedures (Citereasonsforfullstatus.) :  򀀀  򀀀 Se PrintedNameand + K" ,` pL ,` pLXKSignatureofthe_HSC_ԀChair򀀀0  Date򀀀T$T$ ЀAX) xdEjP A k}  @1 k}   _IRB_/_RSSP_ԀUseOnly  !      K ,` Dp ,` pLXKProjectNumber______________________________________0 D Received_RSSP_Ԁ򀀀DV#DT$DT$ Sentto:򀀀󀀀Date:򀀀 % @<<+ FinalStatus  \ n' Approvedas Exempt undersection9.02ofthe_IRB_ԀPoliciesandProcedures( Citereasonsforexemption. ): !) 򀀀 "* 򀀀 x# + Approvedas Expedited underSection9.03ofthe_IRB_ԀPoliciesandProceduresbecause (Citereasonsforexpeditedstatus.)  %"- Ѐ̀ &#/ PrintedNameandSignature:_________________________________________________________________Date___________________?,,XL ,` Dp4?   F  `  h _IRB_Ԁ(fortheCommittee)Approvedby Full reviewunderSection9.04ofthe_IRB_Ԁasmeetingrequirementsofthe_IRB_ԀPoliciesandProcedures. 8+J(5 3// O,,X<3PrintedNameandSignature:򀀀Date򀀀 -*8  C  `  h _IRB_ԀChairperson#,  $,G## f  ,uH# f  ,uH# H-Z*9  C  `  h IRBChairperson#q  $qI##   qI#