INSTITUTIONAL REVIEW BOARD

FWA: 00007392 | IRB: 0004173

2043 College Way | UC Box A-133 | Forest Grove, OR 97116

P: 503-352-1478 | F: 503-352-1447 | E: irb@pacificu.edu

February 7, 2017

Registered: January 31, 2017

Registration Expires: January 31, 2022
IRB Reference Number: 009-17
Project Title: [1011000-1] Dentists and Dental Hygienists Attitudes Towards a Midlevel Dental
Provider
Investigators: Amy Coplen, MS

Review Category: Exempt Review

This letter signifies that the above research project has been reviewed by the Institutional Review Board
at Pacific University and has been registered for five (5) years based on the provided materials. While
being mindful of participant confidentiality, keep this letter on file, along with all informed consent and
release forms, until the expiration date listed above.

As this project was deemed exempt, it does not require continuing review from the IRB. However, if a
research-related incident (i.e., adverse event, issue of noncompliance, unanticipated problem) occurs
during the course of the study, or if you anticipate modifying the project in any way, please complete
the necessary paperwork (available on the IRB website) and submit it to the IRB immediately. As a
researcher, you are responsible for the well-being and safety of your participants.

This project automatically will be closed by the IRB at the end of the five (5) year registration period. A
project closure request will not be necessary. However, if your project lasts for a period of greater than
five (5) years, you must submit a new proposal no less than thirty (30) calendar days before the expiration
date listed above. This is required because federal regulations and/or IRB policies and procedures may
change during the registration period, thereby requiring further scrutiny of the project.

If you have any questions, please do not hesitate to contact Breanna Grove at 503-352-1478 or
irb@pacificu.edu. Please include the Pacific University IRB Reference Number 009-17 and your project
title in all correspondence with this committee.

Sincerely,

Pacific University Institutional Review Board

This letter has been electronically signed in accordance with all applicable regulations, and a copy is retained within Pacific
University's records.

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