Please Attach A COPY OF YOUR SURVEY

INLAND SCIENCE AND ENGINEERING FAIR

Certification OF COMPLIANCE OF

RESEARCH INVOLVING HUMAN SUBJECTS

 

Name of Student                                                                                                                     

Project Title                                                                                                                             

 

Because federal regulations have become increasingly more rigid, students must plan carefully before undertaking research which involves the use of human subjects in either behavioral or biomedical studies. This will protect subjects from unnecessary exposure to physical or psychological risks and experimenters and schools from legal complications.

 

A human subject is legally defined as:

A person about whom an investigator (professional or student) conducting scientific research obtains (1) data through intervention or interaction with the person or(2) identifiable private information.

A subject at risk is legally defined as:

Any individual who may be exposed to the possibility of injury, including physical, psycho­logical or social injury, as a consequence of participation as a subject in any research.

 

Students using human subjects must comply with all regulations that reflect the will of society and plan proper methodology for the protection of those subjects. It is essential that they be alert to humane con­cerns at all times.

 

The following steps must be taken before any student begins research involving subjects:

 

  1. The student completes the “Research Plan” section of this form and submits it to the sponsoring teacher.
  2. The sponsoring teacher reviews the “Research Plan” and determines if ANY POTENTIAL physical, psychological, or social risk is involved (as defined in subject at risk above).

a)                  If none is apparent, the teacher signs the certification. (No additional certification is necessary.)

b)                  If any question exists, the student must redesign the experimental study or plan a different study.

 

NOTE: Any project involving human subjects that is developed with the advice and assistance of personnel at a medical/scientific organization must comply with any regulations of that organization requiring approval of its Institutional Review Board and Informed Consent Certification.

 

RESEARCH PLAN

 

Describe proposed experimental procedures:

 

 

 

 

Explain why human subjects are proposed for this experimentation:

 

 

 

Inland Science & Engineering Fair

Certification of Compliance of Research

Involving Human Subjects

Page Two

 

Describe and assess any potential risk (physical, psychological social, legal or other):

 

 

 

 

 

 

Describe the potential benefits to the individual or society:

 

 

 

 

 

 

Signature of Student _______________________________________  Date _____________

 

 

CERTIFICATION

 

CERTIFICATION BY TEACHER/ADVISOR of compliance with federal regula­tions for the protection of human subjects in behavioral and biomedical research (Must be com­pleted before the start of experimentation.)

 

I certify that, upon reviewing this research plan, I found that the experimental procedures constitute no physical, social, or psychological risk to either experimenter or subjects.

 

I agree to supervise this experimentation and will ensure that it is conducted in a humane, risk-free manner.

Signature ______________________________  Name (Print or Type) ___________________________

Title________________________________________________________________________________

Institution_________________________________________________Phone _____________________

Institution Address ____________________________________________________________________

Home Address _______________________________________________________________________

Home Phone____________________________    Date ____________________________

 

Source of My Expertise/Authority______________________________________________________

 

 

 

This form, properly completed, must be part of the carefully planned procedures of any experiment involving human subjects. It must accompany any such project exhibited at, or presented for, any public display with the Inland Science and Engineering Fair.