Forms and Templates
Information about the categories of review
If you have any questions about whether CPHS review is needed or which forms to use, please contact us.
Note: If your project involves Dartmouth Health, please note that as of 2019, Dartmouth Health has their own IRB. Your project may need to be submitted to the DH IRB instead of or in addition to CPHS. Please contact us with questions prior to preparing an application.
Research plans and protocol templates
- Not Human Subjects Research Application (use this form to request a determination that the project is not human subjects research requiring CPHS review)
- Exempt Application (for human subjects research eligible for a determination of Exemption-see the form for more details)
- Social and Behavioral Research Plan
- Minimal Risk Clinical Research Plan
- Data, Specimens and Registries Research Plan
Consent Form Templates
- Expedited Consent Form Template -for minimal risk studies
- Information Sheet Template
- Waiver & Alterations Request Form
- Assent Form Template
- Consent to Provide Blood and/or Specimens for Research
- fMRI Consent Template
- Full Committee Consent Form Template -for studies involving greater than minimal risk
- Summary Sheet Template
Ancillary Review Forms
supporting documents
- International Research Form
- External Study Team Member Form
- Recruitment Guidance and Template
- Research Involving Children
- Community Based Research Form
- Employee and Student Form
- Genetic Research Form
- Research Involving Individuals Lacking Decision-Making Capacity
- Pregnant Women and Fetuses Form
- Neonates Form
Continuing Review and Reporting forms
(Follow-on Submissions)
- Continuing Review Form & Closure Form
- UPIRSO, SAE, and UADE Reporting Form - for reporting problems and adverse events, submit in RAPPORT via Report New Information (RNI)
- Reporting Flowchart
- Prospective Deviation or Eligibility Exception Request Form – submit via Modification
- Retrospective deviations should be submitted via Report New Information (RNI) however an additional form is not required.
device form
other
- Request for CPHS to Act as Single IRB
- Drug Form: Please contact the CPHS Office prior to preparing a submission involving a drug.