CIRB INITIAL REVIEW APPLICATION This application has been designed to meet the regulatory requirements for review, so answer each question as completely as possible. All answers must be in lay language. If an answer to any question cannot be provided, provide an explanation for the missing answer. If you have any questions regarding the completion of this application, contact the CIRB Helpdesk at or 888-657-3711. STUDY ID: STUDY TITLE: PROTOCOL VERSION DATE: Please provide the protocol and consent form with this Protocol Version Date. STUDY CHAIR Name Institution Name Phone Number Email Administrative Assistant Name Administrative Assistant E-mail Administrative Assistant Phone Number CONTACT PERSON (Person to contact with questions about this application) Name Title Institution Name Phone Number E-mail 1.0 Summary of Study Please answer each of the following questions in 250 words or less per question. 1.1 Indicate the FDA Phase of the study.
CIRB INITIAL REVIEW APPLICATION This application has been designed to meet the regulatory requirements for review, so answer each question as completely as possible. All answers must be in lay language. If an answer to any question cannot be provided, provide an explanation for the missing answer. If you have any questions regarding the completion of this application, contact the CIRB Helpdesk at or 888-657-3711. STUDY ID: STUDY TITLE: PROTOCOL VERSION DATE: Please provide the protocol and consent form with this Protocol Version Date. STUDY CHAIR Name Institution Name Phone Number Email Administrative Assistant Name Administrative Assistant E-mail Administrative Assistant Phone Number CONTACT PERSON (Person to contact with questions about this application) Name Title Institution Name Phone Number E-mail 1.0 Summary of Study Please answer each of the following questions in 250 words or less per question. 1.1 Indicate the FDA Phase of the study.
CIRB_IR%20Application_v042414_Updated_7-7-17.docx