Institutional Review Board (IRB) Application

AP Research

Monday, December 21st, 2020

To the Board members:

Thank you for taking the time to review my IRB application for proposed research as a part of
the AP Research course at High School.

The attached application and addendums have been prepared for review of research ethics and
methodology as proposed for my research project to ensure that they abide by the guidelines set
forth by federal law. You will find the following addressed and provided in this application:

Part I: Project and Researcher Information

Part II: Subjects of Study Checklist
Part III: Further Explanation
Part IV: Researcher Certification and Signature
Part V: Appendices

This application invites approval, questions, or rejection of any research methods involving
humans (including the questions being asked, the population being used, the time and
circumstances under which subjects are studied).

I have reviewed the potential risks to human subjects, and the ethics of research, in order to
determine whether or not the proposed and attached research project can be conducted. I
recognize the purpose of the IRB is to assure that appropriate steps are taken to protect the rights
and welfare of humans or animals participating as subjects in a research study and welcome your
feedback to that end.

Please take the time to review my application below, including any appendices (interview
questions, survey questions, consent forms, permission slips, confidentiality forms, etc.). Please
add your feedback throughout my application as you see fit, complete the attached IRB feedback
and approval form, and sign the last page where you find appropriate.

Thank you for your time and for your expertise. I look forward to receiving this application back
from you.

Thank you,

Gillian Levy
Gillian Levy 

AP Research Student
High School AP Capstone Program
PART I: Project and Researcher Information

AP Research Student IRB Application

Project Director (Teacher):

Expert Adviser:
Institution: HIgh School Discipline: Social Sciences

Project Title/ Research Question: Decision Aids for Unplanned Pregnancies/ How could
pathos and logos approaches to abortion counseling in female health clinics impact the
decision-making process of Colorado females aged 14-24 when seeking options for an
unplanned pregnancy?
Brief Description of gap/ project goal: The gap my research is addressing the lack of
research on decision aids. Specifically many researchers call for more research on how specific
information impacts the aid or conflict during the decision making process. My research will try
to find this answer by looking at how information provided with an appeal to pathos and
information appealing to logos aids or complicates the decision making process in order to get a
step closer to creating a decision aid. A source that outlines the gap I am trying to fill very
specifically is by Donelly et al. (2018). Their article discusses the specific gap that lead me to
this research porject: “Research evaluating DAs on early abortion methods is lacking, and
although many tools are accessible, they demonstrate suboptimal quality” (Donelly et al. 2018).
Their study analyzes external information factors and discovers that, while researchers know
that information aids the decision making process (Vlemmix et al. 2013), minimal research has
been conducted on what information specifically serves as the most effective and helpful
decision aid. Similarly I chose the age rang of 14-24 because research has showed that
adolescent feelings, knowledge, and opinions about abortion recieve little attention despite the
mnay cases of teen pregnancy in the United States each year (Stone and Waszak 1992).
Student Name: Gillian Levy
Project Status (New Project or Revision): New Project
Estimated Data Collection Start and End Dates: January 18, 2021-February 12, 2021
Location of Data Collection: Colorado, United States
Project Type: Student research (under faculty direction)
Class: AP Research
Part II: Subjects of Study Checklist

Does your project involve participants or individuals from any of these special/
vulnerable populations? (Check all that apply.)
Children under 18 years of age
Economically disadvantaged
Individuals with intellectual disabilities
Elderly
Prisoners
Individuals with physical disabilities

Subjects Research Project/Study Checklist (Check YES or NO as appropriate.)

YES NO 1. Does this project or study involve collection of data that identifies individuals
(e.g., cohort databases that include SSN# data on individuals, surveys, or
interviews identifiable by name or student number etc.)?
YES NO 2. Will data identifiable by individual be shared with anyone (such as in a
performance report for a funding source, conference presentations,
published articles and/or reports, etc.)?
YES NO 3. Are the participants being offered one or more of the incentives to
participate (such as money, extra credit for the class, etc.)? List any
incentive(s) here:

YES NO 4. Is participation in this project or study voluntary for the individuals

participating in the program or study?
YES NO 5. Will participants be fully informed about the benefits and any risks?
YES NO 6. Will participants be videotaped or recorded during the project or study?
YES NO 7. Will participants’ privacy and personal information be protected?
Briefly explain how privacy and information will be protected:
All personal information such as emails, names, and everything else
collected within the survey and interview will be kept in a password
secured spreadsheet that no one else except for myself would be able
to see. Within the spreadsheet participants will also be referred to by
their initials so that in the unlikely circumstance someone sees the
spreadsheet they would be unlikely to know who each participant is.
YES NO 8. Will participants be debriefed following completion of the project or study?
YES NO 9. Will participants, prior to the project, indicate informed consent to participate
by completing and signing a written form?
YES NO 10. A sample of these forms included?
YES NO 11. Does the funding source or partner organization have any potential for
financial or professional benefit from the outcome for this study or
project? If yes, please explain.

YES NO 11. Are data sources clearly identified in this application (such as interviews,
survey, existing project data such as services received, reports, grades,
existing school records, focus group, etc.)?
Part III: Further Explanation

Check all that apply and estimate the total anticipated number of individual participants
in each relevant category about whom you will be collecting data on for your project:
High school students Number: 20
General public Number: 20
Faculty Number:_________
Children and Youth under 18 Number: 20

1. Abstract Describing Project and Purpose: Briefly describe (a) the project or study and (b)
what human participants will experience during the proposed study or project. Describe all
strategies or experimental methods to be used, design and program activities. Indicate what
data, measures, or observations will be collected and used in the study or for the project. If any
questionnaires, tests, or other instruments are to be used, include a brief description and one
copy of the instruments in your addendum.
This study is to look at how information with an appeal to pathos versus information appealing
to logos impacts the decision making process of abortion by prociding either ease in decision
making or complicating the decision making process further. Human participants will take a
survey in which they answer questions about their basic demographics (sex, age,
socioeconimic status of their household) as well as answer the question of “would you
consider abortion for an unplanned pregnancy” and then participate in an interview with the
reserahcer. The research will ask the participants to hypothetically consider that they are
experiencing an unplanned pregnancy and are not sure which option of parenting, adoption or
abotrion they would choose. They will be given one of the three stimulus sources (pamphlets
with different information on them) or if they are a part of the control group they will receive no
stimulus. The participant will have 3 minutes to look over the pamphlet before being asked a
series of questions by the researcher to gauge the participants decision confidence based off
of the pamphlet. The questions are to be answered on a scale from one to five and each
group will receive the same questions. After all data is collected, participants will be debriefed
including contextualizing any information that may have been within the pamphlets
(oftentimes information appealing to pathos requires contextualization as it may not always be
medically accurate as far as current statistics go). The participant will also be supplied with
two call lines there to support people struggling with post-abortion mental health struggles or
mental health struggles in general. Participants will also be allowed to ask the researcher
questions at this point (should they have any).

2. Methodology: Specify who the project participants or research subjects will be. Indicate how
they will be solicited, recruited, or contacted. Include any recruitment letters and materials with
this document. State how much time will be required of each participant or subject. Describe
procedures to which individuals will be subjected.
The project participants will be any Colorado aged females aged 14-24. This includes high
school students within The participant will likely need to give
me anywhere from 15-20 minutes of their time depending on how much time they need to fill
out the survey or how much thinking they do for each question. Participants will need to be
willing to answer questions about their families income as well as other demographics, as well
as willing to think about abortion and their emotions towards abortion.

3. Voluntary Participation: Specify the steps that will be taken to ensure that each individual’s
participation is voluntary. State what, if any, inducements will be offered for their participation.
No inducements will be offered as I am hoping that people will simply be willing to participate.
As for voluntary participation I will make sure that people feel no pressure to participate by
making the environment very no-pressure so that participants can voice if they are
uncomfortable or feel they do not want to participate any further.

4. Confidentiality of Data and Privacy Protection: Describe the methods to be used to

safeguard the privacy of participants and ensure the confidentiality of data obtained, including
plans for publication, disposition and destruction of data, including that of computer, print,
videotape, and audio materials. (What will you do with the data after collection and analysis)
As mentioned above, participant information will be kept in a spreadsheet of a password
secured account and only viewed by myself. Within the spreadsheet participants will also be
referred to as Participant # with their initials in parentheses so that in the unlikely
circumstance someone sees the spreadsheet they would be unlikely to know who each
participant is.

5. Informed Consent: Attach a copy of all consent forms to be signed by the participants and/or
any statements to be read to or provided to the participant.

6. Risks to Participants: (a) Describe any potential risks to participating individuals — physical,
psychological, social, legal, or other; (b) include all known and anticipated risks to the
participants such as side effects, risks of placebo (inert) treatments, etc.; and (c) in research
that proposes substantial risk to human participants, list emergency backup procedures that are
in place such as medical or counseling interventions.
There are no social, physical, or legal risks for participants. But, there could possibly be
psychological risks as the questions I ask may or may not be triggering. Should there be any
psychological effects of my study I will supply participants with resources to contact to seek
the help they may need. One of which is the Colorado Crisis Line which is a 24/7 call like to
help people struggling with mental health issues as well as mental emergencies. The other
resource is an organization called 4 exhale and provides nonpartisan support for women and
their family and friends who needed mental support after someone has had an abortion.

7. Benefits: (a) Describe the benefits and/or any compensation that the participating individuals
can expect and (b) describe the gains in knowledge that may result from the project or research
study.
While the participant may not be able to gain any physical things from participating in the
study, they will be able to gain reliable and accurate information on abortion causing them to
likely become more knowledgable on the topic.

8. Human Subjects Research Protection Exemption Categories:

Federal law 45 CFR 46.101(b) identifies the six EXEMPT categories listed below using the
language found in the legislation.
**Check any/all that apply to your project or study and explain why your proposed project or
study falls into the category.

YES NO a. Research conducted in established or commonly accepted educational

settings, involving normal educational practices, such as (i) research on regular and special
education instructional strategies, or (ii) research on the effectiveness of or the comparison
among instructional techniques, curricula, or classroom management methods. Please provide
an explanation as to how your research falls into this category:

YES NO b. Research involving the use of educational tests (cognitive, diagnostic,

aptitude, achievement), survey procedures, interview procedures, or observation of public
behavior, unless: (i) information obtained is recorded in such a manner that human subjects can
be identified, directly or through identifiers linked to the subjects; AND (ii) any disclosure of the
human subjects’ responses outside the research could reasonably place the subjects at risk of
criminal or civil liability or be damaging to the subjects’ financial standing, employability, or
reputation. Please provide an explanation as to how your research falls into this category:

YES NO c. Research involving the use of educational tests (cognitive, diagnostic,

aptitude, achievement), survey procedures, interview procedures, or observation of public
behavior that is not exempt under paragraph (b)(2) of this section, if: (i) The human subjects are
elected or appointed public officials or candidates for public office; or (ii) federal statute(s)
require(s) without exception that the confidentiality of the personally identifiable information will
be maintained throughout the research and thereafter. Please provide an explanation as to how
your research falls into this category:

YES NO d. Research involving the collection or study of existing data, documents,

records, pathological specimens, or diagnostic specimens, if these sources are publicly
available or if the information is recorded by the investigator in such a manner that subjects
cannot be identified, directly or through identifiers linked to the subjects. Please provide an
explanation as to how your research falls into this category:
I will be making sure that subjects of the study cannot be identified by referring to them as
“Participant #” instead of their names. I will also be using a secondary source to help me build
the confidence scale and questions as well as analyze and code qualitative responses.

YES NO e. Research and demonstration projects which are conducted by or subject to

the approval of department or agency heads, and which are designed to study, evaluate, or
otherwise examine: (a) public benefit or service programs; (b) procedures for obtaining benefits
or services under those programs; (c) possible changes in or alternatives to those programs or
procedures; or (d) possible changes in methods or levels or payment for benefits or services
under those programs. Please provide an explanation as to how your research falls into this
category:

YES NO f. Taste and food quality evaluation and consumer acceptance studies, (a) if
wholesome foods without additives are consumed or (b) if a good is consumed that contains a
food ingredient at or below the level and for a use found to be safe, or agricultural chemical or
environmental contaminant at or below the level found to be safe, by the Food and Drug
Administration or approved by the Environmental Protection Agency or the Food Safety and
Inspection Service of the U.S. Department of Agriculture. Please provide an explanation as to
how your research falls into this category:
Part IV: Researcher Certification and Signature

Attachments: Attach all that apply to your proposal. (Check the ones you’ve included with your
proposal. )

REQUIRED
Completed IRB Application
A. Informed consent form(s)
B. Research methodology - Methods Phase II & Operational Definitions
(research design, data source, sampling strategy, etc.)

RECOMMENDED
C. Statement(s) of approval from cooperating entities
(email or on organization letterhead)
D. Outline(s) of proposed questionnaires, surveys, or other data-gathering forms
E. Any letters, flyers, questionnaires, etc. that will be distributed to the study subjects

Certification and Signatures

In making this application, I certify that:

1. I have read and understand the protocol and method of obtaining informed consent, and
will follow them during the period covered by this research project.
2. I agree to comply with federal, state, and local laws regarding the protection of human
participants in research to the best of my knowledge.
3. I will submit any future changes to the research project to the institutional review board
(IRB) for review and approval before implementation, as these may alter the exempt status
of the project.
4. I agree that any new findings that develop during the course of this study that may affect
the risks and benefits to participants will be promptly reported to the IRB in writing.
5. I agree that any adverse events that occur in the course of this study will be promptly
reported to the IRB in writing.
6. I agree and understand that records of the participants will be kept for at least three years
after the completion of the research.
7. I may begin research when the IRB gives notice of its approval.

Signature of the Researcher: Gillian Levy  Date: 12/17/2020

Printed Name: Gillian Levy

APPENDIX A - Informed Consent Form(s)

I am asking you to participate in a research study titled “Decision Aids for Unplanned
Pregnancies.” I will describe this study to you and answer any of your questions. This study is
being led by Gillian Levy, an AP Research Student at Columbine High School. The Faculty Advisor
for this study is , Social Studies Department & AP Capstone.

What the study is about

The purpose of this research is to explore how information appealing to emotion versus
information appealing to logic either aids or complicates the decision making process of young
females considering pregnancy termination. The purpose of this research is not to debate the
ethics of abortion or to say that abortion is right or wrong or that one option is better than
another; this research is just meant to find the most helpful information--meaning the
information that will provide women with the least decision difficulty when needing to make
the decision of parenting, adoption, or abortion for an unexpected pregnancy.

What we will ask you to do

I will ask you to spend about 15-20 minutes in total completing three main tasks. The first of
which is to simply take and online survey covering your basic demographic information (age,
sex, household’s socioeconomic status, etc.) most of which will have a “prefer not to say”
option. After that task is completed, we will begin the two part interview process in which a
hypothetical scenario is proposed in which you are currently experiencing an unplanned
pregnancy and needing to decide what you would like to do in regards to moving forward. Part a
of the process includes you receiving a pamphlet about abortion and reading it over for about 3
minutes. In part b of the interview, you will be asked a series of questions that allow the
researcher to gauge the ease or difficulty in your decision process provided by the pamphlet
you received. After the interview we will have a debrief conversation in which you are
encouraged to ask questions that you may have had throughout the process (should any have
arised). You are also encouraged to advocate for your needs, including needing to exercise the
option of dropping out of the study at any point during the process.

Risks and discomforts

Abortion and unplanned pregnancy can be challanging topics to discuss and therefore may
cause some feelings of sadness, anxiety, or worry. While I will do as much as possible to limit
any possible discomfort or risks, I cannot ensure that you may not feel any emotional distress
after the interview. Should that happen, during the debrief you are provided with two resources
to contact to discuss any emotional distress you may be feeling.

Benefits
The only direct benefit you may experience from participating in this study is learning about
abortion in a non-partisan way, but direct benefits may not be ensured and depend on your
prior knowledge. The main benefit of this research is to fill a research gap that currently exists
within the reproductive world of science. By participating in this study, we are able to know
more about the effects of information on the decision making process, bringing us one step
closer to making a very tough decision a little bit less emotionally taxing through informational
decision aids about all of the options for an unplanned pregnancy (parenting, adoption, or
abortion)

Compensation for participation

I am sorry to say that you will not be receiving any compensation for your participation. But, it
will be incredibly appreciated by the researcher.

Privacy/Confidentiality/Data Security
While surveys and interviews will not be anonymous, all personal and identifying information
will be de-identified before showing research to anyone (including , the teacher of AP
Research). Your name, age, gender, or any other personal information will not be anywhere
within data tables or papers. I plan on keeping a Google Sheet with all of the information that
includes each participant's first and last initial but this document will be for my eyes only and
deleted as soon as possible.

Please note that the survey is being conducted with the help of Google, a company not
affiliated with High School and with its own privacy and security policies that you
can find at its website. We anticipate that your participation in this survey presents no greater
risk than everyday use of the Internet.

Your confidentiality will be kept to the degree permitted by the technology being used. We
cannot guarantee against interception of data sent via the internet by third parties.

Taking part is voluntary

Your participation is entirely voluntary, and you are encouraged to voice your needs during the
research process. If you are feeling uncomfortable or feel that you would no longer like to
participate at any time during the process you are free to withdraw and your information will be
deleted. You will not be penalized in any way for withdrawing from the study or choosing not to
participate. There are some questions during the survey and interview that are mandatory, but
others will have “prefer not to say” options for you to utilize when applicable.

If you have questions

The main researcher conducting this study is Gillian (Gill) Levy, a Junior at High
School. Please ask any questions you have now. If you have questions later, you may contact
Gillian Levy at
If you have any questions or concerns regarding your rights as a subject in this study, you may
contact the Institutional Review Board (IRB) for Human Participants by emailing
at

I have read the above information, and have received answers to any questions I asked. I
consent to take part in the study.
Your Signature Date

Your Name (printed)

Signature of person obtaining consent Date

Printed name of person obtaining consent

This consent form will be kept by the researcher for five years beyond the end of the study.
 APPENDIX B
Method Element Outline - Phase II
Method Description
Subtopic 
On the rubric, a 3 “Describes a replicable research
method, with questionable alignment to the purpose
of the inquiry.”
My approach is to explore the correlation between
Approach information and the decision-making process and how
information specifically targeted to either emotion
and/or logic connects to ease or conflict of decision. explain approaches is common within the social
 
My design is to conduct interviews with participants
Design after giving them a survey on basic demographics.
Participants names will not be asked they will only be body of knowledge.
known on their surveys and interviews as “participant
#” 
Primary/ Secondary
Type of Data I would be collecting primary data as there is not
really any secondary data on this topic. But, I will be
using scales from past research to quantify qualitative
data. The scale is in my Lit Review and it is called the
Dimensions of Decision Difficulty scale and provides
the main four dimensions to decision difficulty.
Independent/ Dependent
Variables My independent variables are the pamphlets that will
be given to participants. There will be three
independent variables with a control group. One
variable (pamphlet and variable will be synonymous
for my purposes) will provide entirely medically
accurate information appealing to logos; the second
will provide information appealing entirely to pathos
and will be taken from the information given by
Crisis Pregnancy Centers. The third pamphlet will
provide half information appealing to pathos and half
appealing to logos. The control will be given no
stimulus. The dependent variable is the ease or
difficulty in the decision-making process.
Quantitative
Applying answers from interviews to the DADD scale
(it is not super quantitative but it does organize it in a
similar fashion).
Method
Qualitative
I will conduct interviews with participants in which I
will ask the same questions for each group and
participant but each cohort will receive different
Justification
On the rubric, a 4 and 5 “Logically defends the
alignment of a detailed, replicable research method to
the purpose of the inquiry.”
How do your approach and design fit into your Body
of Knowledge?
Deductive reasoning and the use of the explore and
sciences and my design of explore to find out more
about the correlation between information and the
decision making process fits with the social science
How do the variables you plan to study connect to
your research question?
The variables I plan on studying align with my
research question because the goal of my research
question is to find which information aids the
decision making process the most. My independent
variables are the information and my dependent
variables are the different cohorts who receive the
independent variables/pamphlets. By making these
my variables I am able to conduct almost an
experiment to measure how the dependent variables
react to the independent variables thus finding the
most helpful information to aid the decision-making
process.
How does your method fit your research design?
Qualitative data and the exploration design often go
hand in hand. Idecided not to approach this through
an entirely qualitative method to maintain internal
validity of the data.
 stimuli. They will be asked to rate their answers on a
scale of 1-5 with 1 being not at all confident/helpful
and 5 being incredibly confident/helpful.
Colorado females aged 14-24.
Subjects of
study
Method Description
Subtopic 
On the rubric, a 3 “Describes a replicable research
method, with questionable alignment to the purpose of
the inquiry.”
Instruments What specific tools (surveys, frameworks, interview
questions, etc.) need to be created?
Zoom, post research counseling services that I could
provide participants with (Colorado Crisis Line and
the 4 Exhale line), questions to ask participants,
survey about basic demographics, informed consent
form, and IRB approval.
How do your subjects connect to your research
question?
My question specifically says that I am looking at the
decision-making process of females aged 14-24 in the
state of Colorado so I think the connection is pretty
air-tight.
Justification
On the rubric, a 4 and 5 “Logically defends the
alignment of a detailed, replicable research method to
the purpose of the inquiry.”
How will your instrument gather the information you
want?
I will use zoom for the interviews which will be
conducted based off of the survey and the interview
questions that I will ask. Those sources will allow me
to compare the results from my interview to the
DADD scale to see which of the three stimulus
options was most effective at decreasing decision
difficulty.
Procedure How will you gather your data, step-by-step (describe How will this process support both internal and
in as much detail as you have)? external validity as well as good research ethics?
My procedure (as of right now) is to give participants (what have you done/ need to do?)
a survey in the form of a Google Form which asks for
basic demographics (age, sex (not gender), By using a scale of 1-5 to measure the participants'
Race/Ethnicity, Socioeconomic Status) as well as if responses upon, I maintain more internal validity
within the study by turning qualitative data into
abortion is something the participant would ever
quantitative data. As abortion can be a tough topic to
consider should they experience and unplanned discuss (especially with a stranger) ethics were taken
pregnancy. Next, I plan on conducting in-depth into consideration with every step of this proces. I am
interviews of women aged 14-24 in Colorado over trying to limit any possible emotional distress by
Zoom or Google Meets. Each participant, regardless providing participants with slips of paper including
of cohort, would be asked to imagine a hypothetical the contact information of two psychological
situation in which they are currently seeking options assistance lines that can be contacted at any time.
for an unplanned pregnancy. They are trying to decide Along with this, I am obviously going to try to limit
any emotional distress experienced by the participant
between parenting, adoption, or abortion. The
at any time during the study by creating a
participant would be told that at this particular point in non-judgemental and comforting atmosphere for them
exploring their options, they are considering abortion to be interviewed within as well as providing a
but am not leaning towards one option more than “prefer not to say” option for any question that may
another. I would have a control group in which I be possibly triggering.
would give a medically accurate pamphlet on abortion
as well as adoption and parenting--all with an appeal
to logos. In another group (group B) I would give
information given to women with an appeal to pathos;
after this survey is completed there would be a debrief
in which all potentially misleading information
presented in the pamphlet would be corrected. In a
third group (group c) I would give a mix of half
information appealing to logos and half appealing to
pathos; after this survey is completed there would be a
debrief in which all false information presented in the
pamphlet would be contextualized. A possible 4th
group that would not receive any stimulus is also
being considered. Each group would get a debrief after
data collection that will allow them to still have
confidence in their decision-making process and
contextualize any information that may have been
medically inaccurate on the pamphlets. Also in the
debrief, as well as at the end of the survey, the
participant will receive two phone numbers of talk
lines they can call at any time should the interview or
study have unintentionally caused any emotional
distress. The first phone number would be for the
Colorado Crisis Line and the second would be for a
post-abortion counseling hotline for women who have
had abortions as well as their friends family or anyone
needing support surrounding the topic of abortion. The
organization is non-partisan and called 4Exhale.
 Operational Definitions

Research Topic:

Concept/ Variable: Operational Definition(s): Measurement tool ( scale, amount, category - quan./
qual. data)

Pathos approach An approach to abortion counseling More than 80 percent of the information on the
in which the clinician appeals to the pamphlet is not based on quantitative data
emotions of the client

Logos approach An approach to abortion counseling More than 80 percent of the information on the
in which the clinician appeals to the pamphlet is based on the most recent accurate
factual side of the client quantitative data

Impacts Causes more ease or difficulty Using a scale of perceived post-decision confidence
within the decision-making process

Demographics Age, sex (not gender), Male, Female (study is only on females), <$20k,
Race/Ethnicity, Socioeconomic $20k-50k, $50k-100k, > $100k
Status
 FOR INSTITUTIONAL REVIEW BOARD MEMBERS’ USE ONLY:

Researcher Name: _____________________________________________

Board Member Name: _________________________________________
Board Member Title: ___________________________________________

I consider this application to be:

Approved
Notes:

_______________________________________________________

_______________________________________________________

Approved, but subject to restrictions

Notes:

_______________________________________________________

_______________________________________________________

Tabled (insufficient information to make a final decision)

Notes:

_______________________________________________________

_______________________________________________________

Rejected
Notes:

_______________________________________________________

_______________________________________________________

Items that Require Modification

Please reference and adhere to the modifications from the domains checked below.
Ethical Considerations
Representation of Institution
Methodology Concerns
Other Concerns

Signature: _________________________________ Date: ________________________