ࡱ> `c_{ BQbjbjBrBr EV  =44444HHH8 dH0p^^^^8$///////$l25v/E4/44^^4:0@@@X4^4^/@/@@$?)^ Z^("/P000)"5,5D?)?)54)@//\05 : Valdosta State University Graduate School Institutional Review Board Oversight Screening Form for Graduate Student Research Project Title:  FORMTEXT      Name:  FORMTEXT      Faculty Advisor:  FORMTEXT      Department:  FORMTEXT      Please indicate the academic purpose of the proposed research:  FORMCHECKBOX  Doctoral Dissertation  FORMCHECKBOX  Master s Thesis  FORMCHECKBOX  Other:  FORMTEXT       E-mail:  FORMTEXT      Telephone:  FORMTEXT       1.  FORMCHECKBOX  YES  FORMCHECKBOX  NO Will you utilize existing identifiable private information about living individuals?  Existing information is data that were previously collected for some other purpose, either by the researcher or, more commonly, by another party. Identifiable means that the identities of the individuals can be ascertained by the researcher by name, code number, pattern of answers, or in some other way, regardless of whether or not the researcher needs to know the identities of the individuals for the proposed research project. Private information includes information about behavior that occurs in a context in which an individual can reasonably expect that no observation or recording is taking place or information provided for specific purposes that the individual can reasonably expect will not be made public (e.g., a medical record or student record). Note: If you are using data that: (1) are publicly available; (2) were collected from individuals anonymously (i.e., no identifying information was included when the data were first collected); (3) will be de-identified before being given to the researcher, (i.e., the owner of the data will strip identifying information so that the researcher cannot ascertain the identities of individuals); or (4) do not include any private information about the individuals, regardless of whether or not the identities of the individuals can be ascertained, your response to Question 1 should be NO. 2.  FORMCHECKBOX  YES  FORMCHECKBOX  NO Will you interact with individuals to obtain data? Interaction includes communication or interpersonal contact between the researcher and the research participant, such as testing, surveying, interviewing, or conducting a focus group. It does not include observation of public behavior when the researcher does not participate in the activities being observed. 3.  FORMCHECKBOX  YES  FORMCHECKBOX  NO Will you intervene with individuals to obtain data? Intervention includes manipulation of the individual or his/her environment for research purposes, as well as using physical procedures (e.g., measuring body composition, using a medical device, collecting a specimen) to gather data for research purposes. If you answered YES to ANY of the above questions, your research is subject to Institutional Review Board oversight. Please discard this form and complete and submit an IRB application. Do not begin your research until your application has been reviewed by the IRB and you are informed of the outcome of the review. ( ( ( ( ( ( ( ( ( ( ( ( If you answered NO to ALL of the above questions, your research is not subject to Institutional Review Board oversight. Stop here, sign below, secure your faculty advisors signature, and submit this form to the Graduate School. Please remember that, even though your project is not subject to IRB oversight, you should still observe ethical principles in the conduct of your research. STUDENT CERTIFICATION: I certify that my responses to the above questions accurately describe my proposed research. Students Signature: ___________________________________________ Date: _____________________ FACULTY 2TV   s_K7#&hEhE5CJ OJQJ\^JaJ&hV"0h!65CJOJQJ\^JaJ&hEh5CJOJQJ\^JaJ&h&(hl<5CJOJQJ\^JaJ&h&(h.M5CJOJQJ\^JaJ h@5CJOJQJ\^JaJ&h&(h 5CJOJQJ\^JaJ&h&(hl<5CJOJQJ\^JaJ)h&(h'56CJOJQJ]^JaJ )h&(h 56CJOJQJ]^JaJ )h&(h;|56CJOJQJ]^JaJ V   $ L   $H$Ifgd!  $H$IfgdC$ H$gd!6$&dH$P^`a$gdRG$&dH$P^`a$gd&($8 d"H$^8 `a$gd&(  " $ & : < > H J L N P R T b d f z | ~ ΝhΝQ-jhlhC$5OJQJU\^J-j2hlhC$5OJQJU\^Jhlh!OJQJ\^Jhlh!5OJQJ\^J2jhlhC$5OJQJU\^JmHnHu-jhlhC$5OJQJU\^J'jhlhC$5OJQJU\^JhlhC$OJQJ\^JhlhC$5OJQJ\^JL N P R T /Xkd$$Ifl(0d* tP+644 laytGE $H$IfgdY $H$Ifgd!Xkdt$$Ifl(0*X% tP+644 laytGET d eVG  $Ifgd! $H$IfgdYkkd$$Ifl(Fd*Xx tP+6    44 laytGE  $H$Ifgd  $H$Ifgd! $H$IfgdC$ " $ . 0 ĴҴeҴRC-+jThlhC$OJPJQJU^JhlhC$OJPJQJ^J%jhlhC$OJPJQJU^J2jhlhC$5OJQJU\^JmHnHu-jhlhC$5OJQJU\^Jhlh!5OJQJ\^Jhlh!OJQJ\^JhlhC$5OJQJ\^JhlhC$OJQJ\^J'jhlhC$5OJQJU\^J2jhlhC$5OJQJU\^JmHnHu 2  H xxhxxY  $Ifgd!  $H$IfgdIB  $H$Ifgd! $H$Ifgd! $H$IfgdC$Xkd$$Ifl(0d* tP+644 laytGE   " $ & J L h j l | ~ ݱݛrdTr@'jhlhC$5OJQJU\^JhlhE5OJQJ\^JhlhEOJQJ\^JhlhC$5OJQJ\^J0jhlhC$OJPJQJU^JmHnHu+jhlhC$OJPJQJU^J+j<hlhC$OJPJQJU^J+jhlhC$OJPJQJU^JhlhC$OJPJQJ^J%jhlhC$OJPJQJU^J t  $Ifgd! $H$IfgdYmkd$$$Ifl4(Fd*Xx tP+6    44 laytGE x  $Ifgd! $H$Ifgd! $H$IfgdC$Zkd$$Ifl4(0d* tP+644 laytGE    ( * , 6 8 : > D F ūhNŝ8+hThN56B*CJOJQJ^Jph2jhlhC$5OJQJU\^JmHnHu-jPhlhC$5OJQJU\^JhlhE5OJQJ\^JhlhEOJQJ\^JhlhC$OJQJ\^J2jhlhC$5OJQJU\^JmHnHu'jhlhC$5OJQJU\^J-jhlhC$5OJQJU\^JhlhC$5OJQJ\^J p  $Ifgd! d$H$Ifgdjmkdt$$Ifl4(Fd*Xx tP+6    44 laytGE  : < o_  $H$Ifgd! d$H$If^`gd! d$H$If^`gdC$Zkd$$Ifl4(0d* tP+644 laytGE< > @ B wg  $H$Ifgd! d$H$If^`gd!mkd$$Ifl4(Fd*Xx tP+6    44 laytGEB D F H ddddJ h^`gdl hH$]^`gdl hpp$dH$N^p`gd H$gdEjZkd9$$Ifl4(0d* tP+644 laytGEF H J N P l n p r λrdVK;h&(ht`56OJQJ^JhzP5OJQJ^JhlhIB5OJQJ^JhlhEj5OJQJ^J+j hlhQ3OJPJQJU^JhlhQ35OJQJ^J+jhlhQ3OJPJQJU^JhlhQ3OJPJQJ^J%jhlhQ3OJPJQJU^JhlhEj5OJQJ\^JhlhE5OJQJ\^J"h&(hE5CJOJQJ\^J , . < V Z j 1ABNfjqӸӣwj`jRHHHhzPOJQJ^Jh&(h_Z>*OJQJ^JhV"0OJQJ^Jhlh%OJQJ^JheoOJQJ^JhAOOJQJ^Jhlh_ZOJQJ^Jh&(>*OJQJ^Jh&(OJQJ^Jh&(5OJQJ^JhlhE5OJQJ^Jheo56OJQJ^Jhlh_Z5OJQJ^Jhlh_Z56OJQJ^Jhlht`5OJQJ^JX_`bcjwAJ-?BŷŠvfVfVfVfVfh&(hV"06CJOJQJ^Jh&(heo6CJOJQJ^JheoheoCJ OJQJ^JhTheoOJQJ]^JhTheoOJQJ^JheoheoOJQJ^Jh&(OJQJ^Jh&(heo>*OJQJ^JheoOJQJ^JheohV"0OJQJ^JheohzPOJQJ^JheohFQMOJQJ^JhFQMOJQJ^JBD %&'(0´~p]N8]N*hlhQ35OJQJ^J+j hlhQ3OJPJQJU^JhlhQ3OJPJQJ^J%jhlhQ3OJPJQJU^Jhlh?=<5OJQJ^Jhlh=*5OJQJ^Jh&(5OJQJ^Jh&(h_ZCJOJQJ^Jh&(h_Z6OJQJ^Jh&(hzP6OJQJ^Jh&(hV"06OJQJ^Jh&(heo6OJQJ^Jh&(heo6CJOJQJ^J"h&(heo6>*䴳ϴ01?ݹdz۳5l%ϴ@ϴl?=<OJQJ^JhTOJQJ^JhTh?=<>*ϴT5Oϴl?=<5OJQJ^J$hlh=*56OJQJ\]^Jhlht`5OJQJ^Jhlh=*5OJQJ^JhlhQ35OJQJ^J+j hlhQ3OJPJQJU^JhlhQ3OJPJQJ^J%jhlhQ3OJPJQJU^J$&2ٶ{e{{O{+j hlhSOJPJQJU^J+jp hlhSOJPJQJU^JhlhSOJPJQJ^J%jhlhSOJPJQJU^JhlhS5OJQJ^Jh&(5OJQJ^Jh&(h?=<CJOJQJ^JhTOJQJ^JhzPOJQJ^Jhlh?=<OJQJ^JhlhrOJQJ^Jhlht`OJQJ^J bc{}wxjeegdA hbL^`Lgd $a$gdC$ hbgdE hbgdC$ hbb^b`gd  h^`gdl hH$]^`gdl (*  7:acõvi\K8K8K$hlhC$56>*ϴ^!lC$56Oϴ^lEϴlSϴl%ϴl?=<OJQJ^JhlhrOJQJ^JhTOJQJ^JhTh?=<>*OJQJ^JhTht`>*OJQJ^JhT5OJQJ^JhlhS5OJQJ^J!hlhS5OJQJ\]^J$hlhS56OJQJ\]^Jbcdefghijklmnopqrstuvwxyz{|}~ͺveT!hlhE56OJQJ]^J!hlht`56OJQJ]^J!hlh 56OJQJ]^J%hGEhC$56CJOJQJ]^JhGE56CJOJQJ]^JhlhC$5OJQJ\^J$ jwhlhC$5OJQJ\^J%hGEhC$56CJ OJQJ]^J!hlhC$56OJQJ]^JhC$56OJQJ]^J   c˽ܬzl^P^?!hlh%5>*OJQJ\^JhT56OJQJ]^Jh&(56OJQJ]^Jh,mo56OJQJ]^JhC$56OJQJ]^J$hlh 56>*OJQJ]^J!hlh 56OJQJ]^J!hlh%56OJQJ]^JhzP56OJQJ]^J!hlht`56OJQJ]^J!hlhE56OJQJ]^J$hlhE56>*OJQJ]^J)uvwxyPP>PPPPPƶra_N>>hlh 5OJQJ\^J!hlh%5>*OJQJ\^JU!hlh 5>*OJQJ\^J"hV"0hQ35CJ OJQJ\^J"hThQ35CJOJQJ\^JhlhE5OJQJ\^Jhlhl<5OJQJ\^JhlhC$5OJQJ\^Jh%5OJQJ\^JhzP5OJQJ\^JhlhcO#5OJQJ\^Jhlh%5OJQJ\^JxyPPQQQ Q Q Q QQQQ?Q@QAQBQ$$ 0*H$gd&($$  0*$dH$Ngd&(gdl<`gdzngdAADVISOR CERTIFICATION: I have reviewed the students proposed research and concur that it is not subject to Institutional Review Board oversight. 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