Is My Project Human Subjects Research?
Title of Project:
Principal Investigator (Faculty Supervisor if Student Research)
Name:	E-mail:
Department/Division/School:
Co-Investigator
Name:		E-mail:
Department/Division Chair or School Director
Name:	E-mail:
I.  The activities that I am planning may result in: Y ☐      N ☐     a culminating project to satisfy a graduation requirement Y ☐      N ☐     a thesis to satisfy a graduation requirement? Y ☐      N ☐     a presentation at a scholarly professional meeting, current or future Y ☐      N ☐     a publication, current or future [Attach explanation if you are uncertain]
II. I want to interview, survey, systematically observe, or collect other data from human subjects, for example, students in the educational setting. Y ☐      N ☐     [Attach explanation if you are uncertain.]
III. I want to access data about specific persons that have already been collected by others [such as test scores or demographic information]. Those data can be linked to specific persons [regardless of whether I will link data and persons in my research or reveal anyone’s identities]. Y ☐      N ☐     [Attach explanation if you are uncertain.]
If you answered “No” to every option in “I”, your project is not human subject’s research, regardless of your answers in “II” and “III”. Please sign and submit this form with signatures as a PDF to irb3@calstatela.edu . If you answered “No” to BOTH “II” and “III”, your project is not human subjects research, regardless of your answers in “I”. Please sign and submit this form with signatures as a PDF to irb3@calstatela.edu with a brief explanation of the project. If you answered “Yes” to any option in “I” AND “Yes” to “II”, do not submit this form. See Cal State LA IRB Guidelines (http://www.calstatela.edu/orsca) and submit the appropriate IRB Application Form . If you answered “Yes” to any option in “I” AND “Yes” to “III”, do not submit this form. Submit the IRB Waiver Application through IRBNet unless you plan to obtain informed consent from the persons whose data you will access, in which case, submit the IRB Application Form through IRBNet.
Signature and Name of Principal Investigator:			Date:
Signature and Name of Co-Investigator:			Date: