SummaryReport.doc

Research Interim Review / Completion Form Instructions: Complete the top of this page in space given. Enter responses to the numbered questions below by entering information directly on this form or use a form downloaded from the IRB page on . Submit this completed form, preferably electronically, to the IRB Administrator before due date noted on your IRB approval form. Interim research reports are required annually (or more frequently, if requested by the IRB) as long as the study continues, including the final year of the investigation (in which it serves as notice to the IRB that the research is complete). Principle Investigator (name, and title/position): _________________________ Date: __________ Short Title of Project: _______________________________________________________________ This report is (check one): ( Annual Report ( Required Interim Report ( Unscheduled Interim Report ( Final / Completion Report (Other Report Status: Data collection (date ended): ____________ Data analysis (date ended): _________ (If study is continuing, indicate anticipated end / analysis dates.) Number of subjects currently enrolled: _______ Number of subjects still to be enrolled: ______ Results: If data analysis is now complete, describe the results in one paragraph and add to this page. Do not provide figures or charts. With whom the results will be shared or have been shared: How participants will be informed about overall results, and any anticipated local impact: If the research is toward a degree, indicate expected publication date for thesis or dissertation: If relevant, state how the work will be continued, where, when, and by whom: Ethical Concerns: If there were any ethical concerns that came to your attention about any facet of the research, or if any adverse events were reported, describe these and how they were resolved: PI signature: ______________________________________________________ Date: __________ Advisor or Co-investigator signatu