Application
for Approval 
Institutional Review Board
Research Involving Human Subjects Office of Scholarly Research
Tel:
616-471-6361 ~ Fax: 616-471-6246
INSTRUCTIONS:
Your application will not be
processed unless ALL the relevant documentation has been submitted and is
legible.
Use this form as a cover
sheet and attach to it the following items: (1) The appropriate Research
Protocol, (2) An Informed Consent Form (if required), (3)
And Abstract and, (4) Other documentation as neededCover
Letter of Explanation. Question Sample. Written Copy of Verbal Instructions,
and/or Letters of Permission.
Submit the required number of full sets (1 set for Exempt; 3 sets for
Expedited; and 18 sets for Full Review) to Andrews University, Office of
Scholarly Research, Room 210 Administration Building, Berrien Springs, MI
49104-0355.
SUGGESTED CATEGORY OF IRB REVIEW
The investigator(s) should
read carefully the Brief Guidelines for Human Subjects Research
and discuss with his/her/their advisor and/or department chair the relationship
of the present research project to the policies and procedures contained in the
above document. After this consultation
the investigator(s) should request that the research project be considered by
the IRB under one of the categories listed below. Final assignment of the review category is
made by the IRB. The
frequency of IRB review action is noted by the respective review
category.
[ x ] Exempt from Full IRB [ ] Expedited
IRB Review [ ] Full
IRB Review
Review [Weekly Review] [Monthly
Review] [Quarterly
Review]
No risk/minimal risk
research: fill out Exempt Category Checklist on page 2. Submit the
appropriate documentation two weeks
prior to the next Scheduled
meeting of the IRB
DESCPRIPTION OF RESEARCH PROJECT
Project Title: Dual
Enrollment/Dual Credit Programs: A Survey of Current Practices and the Need for
Dual Enrollment/Dual Credit Programs within Adventist Education
Academic Department of Researcher: Education Department: Leadership
Beginning and Ending Dates of Human Subjects
Involvement in Research: January 2004 to March 2004
Place/Location of Human Subject Involvement in Research: Adventist Colleges and Universities (Administrative level only); Adventist academies (registrars); homes or offices of church clerks in the North American Division; homes or meeting rooms for focus groups of parents of students at the academy level
Target Population (Description and Age Range): adults
(age range will vary; there are no plans to include any minors in this study)
INVESTIGATOR(S) AGREEMENT
I (we) hereby agree to abide
by the terms and methodology as outlined in the attached research
protocol. I (we) also agree to begin the implementation of this projectif
not approved under the exempt categoryonly after written notification of
its approval (valid for one year) has
been received. Furthermore, I (we)
agree that in cases involving research to be conducted at non-university
site(s), such research will commence only after written authorization has been
received from an officer of the organization at each site involved and filed
with our Office of Scholarly Research.
Notification of any alterations in the attached protocol will be
submitted to the Director of the Office of Scholarly Research.
Name: Shelley Ann Bacon Name:
. Name:
E-mail: bacon.home@juno.com E-mail:
E-mail:
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Address: 556 Hotchkiss Road Address:
.
. Address:
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Colville, WA 99114
Tel: 509-684-1005 Tel:
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. Tel:
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Cell: 509-675-5003
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(Principle Investigators Signature)
(Date) (Principle Investigators Signature) (Date) Principle
Investigators Signature) (Date)
SUPPORTING NAME AND SIGNATURE
I have reviewed the above
project with the investigator(s) and concur in the requested category of IRB
review.
Shirley Freed
... _________________
Name of AdvisorBlock Letters Signature
of Advisor Supervising Research Date
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ABSTRACT OF PROJECT AbstractMasters in Leadership Thesis Shelley Bacon bacon.home@juno.com 509-684-1005 Dual Enrollment/Dual Credit Programs: A Survey of Current Practices
and the Need for Dual Enrollment/Dual Credit Programs within Adventist
Education Problem: Public higher education and high school programs are collaborating to provide dual enrollment/dual credit programs for qualifying seniors and/or juniors and seniors. These programs are widely available and almost always free. Adventist faith-based education has no comparable program to fill this need. Adventist LEAP Leading Edge Accelerated Program needs to be established to meet the academic needs of accelerated Adventist high school students from a distinctly Adventist faith-based perspective. This thesis paper will outline the following:
·
Current felt needs for academically challenging
coursework to be made available to accelerated students (focus groups) ·
Summary of need for distinctly Adventist, faith-based
dual enrollment/dual credit program through distance learning |
EXEMPT CATEGORY CHECKLIST
If your proposed research
project does not place the subjects at more than minimal risk and
is included in one of six categories of research which are exempt from full
review under the provisions of the Cod of Federal Regulations for the
protection of human subjects from research risk, indicate the category(s) that
apply to the proposed project placing a check in the appropriate box below.
Even if exempt from full IRB
review, all research projects must make provision for compliance with
published guidelines for obtaining informed consent and maintaining
confidentiality. Some research listed
below, if involving prisoners and/or directed toward pregnant women or other
vulnerable populations groups, is not exempt.
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1 |
Research
conducted in established or commonly accepted educational settings, involving
normal educational practices such as: (a)
Research
on regular and special education instruction strategies, (or) (b)
Research
on the effectiveness of, or the comparison among, instructional techniques,
curricula, or management only. |
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2 |
Research
involving the use of educational tests (cognitive, diagnostic, aptitude,
achievement), survey or interview procedures, or observation of public
behavior UNLESS ALL of the following conditions exist: (a)
Responses
are recorded in such a manner that the subjects can be identified directly or
through identifying links, and (b)
The
responses, if they become known outside the research, could reasonably place
the subject at risk of criminal or civil liability, or be damaging to the
subjects financial standing, employability, or reputation. Note: The following types of Category 2 Exemptions do NOT apply to
research where children (minors) are subjects: Survey Research, Interview Research, Observation of Public
Behavior in which an investigator is a participant. |
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3 |
Research
of the type listed in Category 2 which under the above provisions is not
exempt but which does qualify for exemption if: (a)
The
human subjects are elected or appointed public officials or candidates for
public office, or (b)
Federal
statue(s) require(s) without exception that the confidentiality of the
personally identifiable information will be maintained throughout the
research and thereafter. |
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4 |
Research involving the collection or study of
existing data, documents, records, pathological specimens, or diagnostic
specimens and these sources are publicly available, or if the information is
recorded by the investigator in such a way that the subjects CANNOT be
identified directly or through identifiers linked to the subjects. |
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5 |
Research
and demonstration projects which are conducted by or subject to the approval
of federal department or agency heads, and which are designed to study,
evaluate, or otherwise examine: (a)
Public
Benefit or Service Programs (b)
Procedures
for obtaining benefits or services under those programs (c)
Possible
changes in or alternatives to those programs or procedures (d)
Possible
changes in methods or levels of payment for benefits or services under those
programs. |
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6 |
Taste and food quality evaluation and consumer
acceptance studies if wholesome foods without additives are consumed, or if a
food is consumed that contains a food ingredient at or below the level and
for a use found to be safe or agricultural, chemical, or environmental
contaminant at or below the level
found to be safe by FDA or EPA or USDA determination. |
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In signing this form
requesting exempt status, I (we) assure the Institutional Review Board that the
only involvement of human subjects will comply fully with the criteria for one
of the above exemption categories.