Forms and Templates
Information about the categories of review
If you have any questions about whether CPHS review is needed or which forms to use, please contact us.
(*Note: If your project involves Dartmouth-Hitchcock: please review the criteria for determining whether your applications should be sent to the D-H IRB rather than CPHS here.*)
Research plans and protocol templates
- Not Human Subjects Research Application (use this form to request a determination that the project is not human subjects research requiring CPHS review)
- Exempt Application (for human subjects research eligible for a determination of Exemption-see the form for more details)
- Social and Behavioral Research Plan
- Minimal Risk Clinical Research Plan
- Data, Specimens and Registries Research Plan
Consent Form Templates
- Expedited Consent Form Template -for minimal risk studies
- Information Sheet Template
- Waiver & Alterations Request Form
- Assent Form Template
- Consent to Provide Blood and/or Specimens for Research
- fMRI Consent Template
- Full Committee Consent Form Template -for studies involving greater than minimal risk
- Summary Sheet Template
Ancillary Review Forms
supporting documents
- International Research Form
- External Study Team Member Form
- Recruitment Guidance and Template
- Research Involving Children
- Community Based Research Form
- Employee and Student Form
- Genetic Research Form
- Research Involving Individuals Lacking Decision-Making Capacity
- Pregnant Women and Fetuses Form
- Neonates Form
Continuing Review and Reporting forms
(Follow-on Submissions)
- Continuing Review Form & Closure Form
- UPIRSO, SAE, and UADE Reporting Form - for reporting problems and adverse events, submit in RAPPORT via Report New Information (RNI)
- Reporting Flowchart
- Prospective Deviation or Eligibility Exception Request Form – submit via Modification
- Retrospective deviations should be submitted via Report New Information (RNI) however an additional form is not required.
device form
other
- Drug Form: Please contact the CPHS Office prior to preparing a submission involving a drug.