All Mercer Protocol Forms
REMEMBER:
- TYPE all information - The IRB will reject applications that are not typed.
- For processing purposes, Microsoft Word documents MUST be submitted in Microsoft Word format - do NOT convert to PDF.
- Fillable text fields and dropdown menus available in some of the following forms require access to Microsoft Word 2010 or higher (or a Microsoft OneDrive account). If you are unable to access this software, Mac-friendly versions are available upon request.
New Study Applications
New IRB Affiliated Faculty Minimal Risk Application (Microsoft Word)
New IRB Mercer Student and Resident Minimal Risk Application (Microsoft Word)
New IRB Non-Affiliated Faculty Minimal Risk Application (Microsoft Word)
New IRB Non-Mercer Student Minimal Risk Application (Microsoft Word)
New IRB Mercer Clinical Trial Application (Microsoft Word)
New Navicent Mercer IRB Joint Protocol Application (Mircrosoft Word)
New IACUC Protocol Application with Congruency (Microsoft Word)
Amendments and Modifications
IRB Affiliated Faculty Minimal Risk Modification Application (Microsoft Word)
IRB Mercer Student and Resident Minimal Risk Modification Application (Microsoft Word)
IRB Non-Affiliated Faculty Minimal Risk Modification Application (Microsoft Word)
IRB Non-Mercer Student Minimal Risk Modification Application (Microsoft Word)
IRB Clinical Trial Modification Application (Microsoft Word) - for amendments and informational items
IACUC Protocol Modification Application (Microsoft Word)
IACUC Research Personnel Amendment Form (Microsoft Word)
Continuing Review Applications
IRB Affiliated Faculty Minimal Risk Continuing Review Application (Microsoft Word)
IRB Mercer Student and Resident Minimal risk Continuing Review Application (Microsoft Word)
IRB Non-Affiliated Faculty Minimal Risk Continuing Review Application (Microsoft Word)
IRB Non-Mercer Student Minimal Risk Continuing Review Application (Microsoft Word)
IRB Clinical Trial Continuing Review Application (Microsoft Word)
IACUC Continuing Review Application with Congruency (Microsoft Word)
Informational Items
Please submit informational items for IRB review using a Clinical Trial Modification Application (Microsoft Word).
IRB FDA 1572 (Adobe PDF)
IRB Statement for Payments to Human Subject Participants (Microsoft Word) - Note: This form is already included in the Clinical Trial Informed Consent Document.
Informed Consent Templates
Mercer Clinical Trial Informed Consent with Statement of Payment (Microsoft Word)
Standard Mercer Informed Consent Template (Microsoft Word)
Mercer Informed Consent Template with HIPAA (Microsoft Word)
Debriefing Statement for Deceptive ICFs (Microsoft Word)
Subject Information Sheet (Microsoft Word)
Online Web Consent Template (Microsoft Word)
Online Survey Recruitment Email Template (Microsoft Word)
Verbal Assent of Minors in Pre-K (Microsoft Word)
Verbal/Informed Assent of Minors in Grades 3-6, Ages 12 and Under (Microsoft Word)
Informed Assent of Minors Ages 12-14 (Microsoft Word)
Informed Assent of Minors Ages 14-18 (Microsoft Word)
Informed Parental Consent - School Setting (Microsoft Word)
Parent or Guardian HIPAA Authorization vJan2018 (Microsoft Word)
HIPAA Authorization Waiver
Request for Waiver or Alteration of HIPAA Authorization vJan2018 (Microsoft Word)
Permissions and Requests
IRB Research Request for Use of Student Records (Microsoft Word)
IRB School Research Request (Microsoft Word)
IACUC Request for Non-Designated Animal Housing (Microsoft Word)
Event Reports
IRB Adverse Event Behavioral Form (Microsoft Word)
IRB On-Site Adverse Event Report Form (Microsoft Word)
IRB Protocol Deviation/Violation Form (Microsoft Word)
Study Closure or Withdrawal
If your study involved one or more online surveys created through the ORC's SurveyMonkey services, please remember to email ORC_Online_Survey@Mercer.edu and request the closure of any surveys associated with your application.
IRB Faculty Minimal Risk Research Final Report (Microsoft Word)
IRB Student Minimal Risk Research Final Report (Microsoft Word)
IRB Clinical Trial Final Report (Microsoft Word)
IACUC Protocol Closure Report (Microsoft Word)
