7# [[[[[iiiii s }}}}} JStatement of Exemption From Human Subjects Review Union College A few categories of research are exempt from review by the Human Subjects Research Review Committee. These categories of research, which appear in The Code of Federal Regulations (Title 45), are listed in the Guidelines for Faculty and Students Engaged in Human Subjects Research at Union College. They are explained in more detail in the Institutional Review Board Guidebook. If you and your faculty advisor deem that your research proposal does not require human subjects review, please complete this form and submit it to the Deans Office in Science and Engineering (S-100). You may begin your research after submitting the exemption form. If your proposal requires human subjects review or if you are uncertain whether your proposal requires review, please submit a Statement of Intention to Engage in Human Subjects Research Form. Title of Project___________________________________________________________ Student Name(s) _________________________________________________________ Local address____________________________________________________________ Email address_______________________________ Phone________________________ Please provide a description of your study, explaining the purpose and the procedures. Do not simply attach a copy of your IEF proposal. If a questionnaire is to be used, a copy must be included with the application. If an interview procedure is to be used, the types of questions that will be asked should be described. If deception is used, you must explain either how the subject will be debriefed or why they will not be debriefed. You may use additional sheets or attach your entire description of the project to this form. This Section to be Completed by Student, Faculty and Staff Researchers I have reviewed the guidelines for determining exemption status and am confident that the proposed research is exempt from human subjects review. The category exemption number(s) is (are) _________________________. I understand that although my research project is exempt from review, this does not relieve me of any responsibilities relating to research subjects. I also understand that it is a violation of New York State Public Health Law to conduct non-exempt research involving human subjects without approval from the Human Subjects Research Review Committee. Student Signature(s) ____________________________________ Date______________ This Section to be Completed by Faculty Research Advisors Only I have read the students research proposal, have reviewed the guidelines for determining exemption status and am confident that the proposed research is exempt from human subjects review. The category exemption number(s) is (are) ______________________. I have explained to the student that although his/her research project is exempt from review, this does not relieve him/her of any responsibilities relating to research subjects. I also understand that it is a violation of New York State Public Health Law to conduct non-exempt research involving human subjects without approval from the Human Subjects Research Review Committee. Faculty Name____________________________________________________________ Faculty Signature______________________________________ Date_______________ h2@oN| 6 @@@@2@A)*uv 7 8   s t u    6captionTitle(     =/BJ1Statement of Exemption From Human Subjects ReviewAcademic ComputingTimes New Roman{Times New Roman CE|Times New Roman Cyr~Times New Roman GreekTimes New Roman TurTimes New Roman (Hebrew)Times New Roman (Arabic)Times New Roman Baltic