Forms

Information about the categories of review

Full Committee

Expedited

Exempt

Student Research

VA Specific

Data Analysis

Reporting and Other

Full Committee Forms

• Full Committee Application Checklist
• Full Committee Human Subjects Review Form for new projects
• Departmental Scientific Review Form
• Full Committee CPHS Study Plan
• CPHS Study Plan Attachments
• Full Committee Consent Form Template
• Assent Form Template
• Renewal / Termination Form
• Revision and Addition Request Form

Expedited Study Forms

• Expedited Application Checklist
• Expedited Human Subjects Review Form for new projects
• Expedited CPHS Study Plan
• CPHS Study Plan Attachments
• Expedited Consent Form Template
• Assent Form Template
• Consent to Provide Blood for Research
• fMRI Consent
• Information Sheet Template
• Renewal / Termination Form
• Revision and Addition Request Form

Exempt Study Form

Please note: Do not use the "Exemption Review Form" to apply for CPHS review of activities that do not involve human subjects research, such as quality improvement, program evaluation, and public health activities without a research component.  The CPHS only reviews human subjects research.  "Exemption from further review" is the level of CPHS review applied to certain categories of research activities involving human subjects that satisfy specific regulatory criteria.  The use of the word "exempt" does not mean the project does not need CPHS review or that participant permission for research participation is not needed.  The CPHS will review the project and, if applicable, grant the designation "Exempt from further review".

• Exemption Review Form

Student Research Forms 

• Student Research Project Application Checklist
• Student Project Human Subjects Review Form
• Information Sheet Template example for Undergraduates   

Please note: For student researchers, the only unique forms are the cover page signed by the faculty advisor and the information sheet template (if the study uses an information sheet). All of the other required application forms are the same as the forms for all other researchers, as noted on the student application checklist.

VA Specific Forms

• VA Consent Form Template Instructions
• VA Consent Form Template
• VA Authorization Form Template

Data Analysis Only Form

• Research Use of Information or Specimens Use this form for research or database development involving only:
  • clinical health information or
  • specimen use or
  • use of secondary research information or specimens

Other Forms

• Serious Adverse Event (SAE) and Unanticipated Adverse Device Effect (UADE) Reporting Form for Clinical Trials
• Unanticipated Problem Involving Risks to Subjects or Others (UPR) Reporting Form
• Protocol Deviation Form
• Eligibility Exception Request
• Conflict of Interest Reporting Form for Human Subject Research
• Facilitated Review Form
• Preparatory to Research  This provision might be used, for example, to design a research study or to assess the feasibility of conducting a study.
• Alternate W9 Form
• Payments for Clinical Trials Form