"Cover Sheet - Institutional Review Board" - Florida

Cover Sheet - Institutional Review Board is a legal document that was released by the Florida Department of Juvenile Justice - a government authority operating within Florida.

Form Details:

  • Released on April 18, 2014;
  • The latest edition currently provided by the Florida Department of Juvenile Justice;
  • Ready to use and print;
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  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Florida Department of Juvenile Justice.

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FLORIDA DEPARTMENT OF JUVENILE JUSTICE
Institutional Review Board
Cover Sheet
Project Title: _______________________________________________________________________________________________
________________________________________________________________________________________________
Name of Principal Investigator: _______________________________________ Title: ___________________________
University/Research Institution: __________________________________________________________________________
Department: ________________________________________________________________________________________________
Mailing Address: ___________________________________________________________________________________________
___________________________________________________________________________________________
Email Address: ________________________________________________ Telephone #: (_______)____________________
Purpose of this study? ____ Dissertation ____ Thesis ____ Grant
Other: _____________________________
I approve this protocol for submission to the Institutional Review Board.
___________________________________________________________________________________
Dissertation/Thesis Chairperson
Date
Co-Investigators: ___________________________________________________________________________________________
What are the research questions? _________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
The following items have been included in the application packet (N/A, if not applicable):
_____ Introductory Questionnaire
_____ 5-page Research Background and Protocol
_____ Research Acknowledgement Form for the DJJ program(s) involved (Above Dotted Line Only)
_____ Copies of all forms/instruments
_____ University/Agency Human Subjects Approval Letter
_____ Data Request Form
The principal investigator has read the Institutional Review Board handbook: _____Yes _____No
The undersigned accepts the responsibility to comply with Federal, State, and Department of
Juvenile Justice policies related to the protection of the rights and welfare of human subjects.
____________________________________________________________________________________
Signature of Principal Investigator
Date
2737 Centerview Drive
Tallahassee, Florida 32399-3100
(850) 488-1850
4/18/14
http://www.djj.state.fl.us
The mission of the Department of Juvenile Justice is to increase public safety by reducing juvenile delinquency through effective
prevention, intervention and treatment services that strengthen families and turn around the lives of troubled youth.
FLORIDA DEPARTMENT OF JUVENILE JUSTICE
Institutional Review Board
Cover Sheet
Project Title: _______________________________________________________________________________________________
________________________________________________________________________________________________
Name of Principal Investigator: _______________________________________ Title: ___________________________
University/Research Institution: __________________________________________________________________________
Department: ________________________________________________________________________________________________
Mailing Address: ___________________________________________________________________________________________
___________________________________________________________________________________________
Email Address: ________________________________________________ Telephone #: (_______)____________________
Purpose of this study? ____ Dissertation ____ Thesis ____ Grant
Other: _____________________________
I approve this protocol for submission to the Institutional Review Board.
___________________________________________________________________________________
Dissertation/Thesis Chairperson
Date
Co-Investigators: ___________________________________________________________________________________________
What are the research questions? _________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
The following items have been included in the application packet (N/A, if not applicable):
_____ Introductory Questionnaire
_____ 5-page Research Background and Protocol
_____ Research Acknowledgement Form for the DJJ program(s) involved (Above Dotted Line Only)
_____ Copies of all forms/instruments
_____ University/Agency Human Subjects Approval Letter
_____ Data Request Form
The principal investigator has read the Institutional Review Board handbook: _____Yes _____No
The undersigned accepts the responsibility to comply with Federal, State, and Department of
Juvenile Justice policies related to the protection of the rights and welfare of human subjects.
____________________________________________________________________________________
Signature of Principal Investigator
Date
2737 Centerview Drive
Tallahassee, Florida 32399-3100
(850) 488-1850
4/18/14
http://www.djj.state.fl.us
The mission of the Department of Juvenile Justice is to increase public safety by reducing juvenile delinquency through effective
prevention, intervention and treatment services that strengthen families and turn around the lives of troubled youth.