Institutional Review Board Research Close-out Form

Directions to Researchers: The Principal Investigator (PI) shall submit a close-out form for non-exempt research when data collection and analysis are completed within the scope of the IRB approved protocol. If the PI intends to deviate from the original purpose stated on the application and approved by the IRB, the PI must submit a new application to the IRB.

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Protocol ID:

Protocol Title:

Principal Investigator or Researcher

Name:

Institutional Affiliation:

Email:

Phone:

Research Results

Status of Research

Never Started

Completed

Please check one.

Describe the Circumstances

Problems Encountered During Research

Describe any problems that you may have encountered during the research related to protection of human subjects:

Describe how these problems were resolved:

Use of Research

How have the data been used, up to this point? Provide references to any publications (including that of a thesis or dissertation) or conference presentations that involve data from this study: