Complete Protocol Application Form
This form is to be used for all types of human subjects research (exempt, expedite, and full board review). Please provide answers to all of the following questions. All projects submitted for review must be typed (no handwritten proposals accepted). If a question does not apply put not applicable. Do not leave any answers blank.
Attach Documents to Application
Attach the following applicable documents as appendices to the application. It is recommended that you include a table of contents identifying all appendix materials. Use titles that are consistent with those that you might reference in the text of the application.
Conflict of Interest Statement for PI and Co-I
Consent Form/Information Sheet
Parental Permission Form/Minor Assent Form
Site Authorization Letter (for study conduct and/or access to administrative records)
Device Manual (if using an approved or investigational device)
Any other documents related to the research
After review by the Department Review Committee and all signatures have been obtained, please forward their opinions and comments along with the signatures on the Assurances to the Human Subjects Protection Program Office. Only one copy is required and will be retained for the Human Subjects Protection Program files and eventually archived for a permanent record.
Please submit all documents to:
Campus Mail: MS 2800 In Person: Office of Regulatory Research Compliance, Delco, Suites 163 and 164 Off Campus: Marcia Shelton, P. O. Box 519, Prairie View, Texas, 77446
If you have any questions or need assistance completing this application, please call (936) 261-1553 or email Research@pvamu.edu
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