Gorgas Human

Supervising Teacher or Scientist Additional Approval Forms
Alabama Science Scholar Search and Gorgas Scholarship Competition

INSTITUTIONAL REVIEW BOARD (IRB) APPROVAL FORM*
FOR PROJECTS INVOLVING HUMAN PARTICIPANTS

The rules for these projects are published in the Rules & Regulations booklet at https://student.societyforscience.org/international-rules-pre-college-science-research

This form should be created, signed by the 3 IRB committee members, scanned and emailed togorgasscholarshipcompetition@gmail.com or ebbuckner@gmail.com with the subject of Gorgas-student last name – human

Please provide the student name, high school and the institution providing approval. The committee should answer the following questions:

A. Explain why human subjects are proposed or necessary for this project.
B. Describe and assess any potential risk (physical, psychological, social, legal, or other).
C. Describe minimal risks involved and if more than minimal, the consent procedures to be followed and attach a sample of the completed consent form.
D. Describe procedures to minimize risks.
E. Describe benefits to the individual or society.
F. Explain how the benefits exceed the risks.
G. Approved by Institutional Review Board (IRB) (To be completed by the IRB prior to experimentation; a minimum of 3 members required, one science teacher, one health related professional and one administrator)

* If the institution approving this project has a different form that contains essentially this same information, the institution’s form may be used.

IRB members print your name, sign, date and identify your role

a. Scientist/Science Teacher:
b. Physician/Psychiatrist/Physician’s Assistant/Licensed Psychologist/Registered Nurse/Licensed Social Worker/PharmD
c. School Administrator (preferably Principal or Vice Principal):