Project Closure Form

Lourdes University Institutional Review BoardResearch Project Closure FormInstructions:FacultyFFfffkkdkdkdkdkFNote: Consent forms must be retained for 3 years after research closure, then destroyed.IRB project #_______IRB Approval Date ________Review type: Expedited____ Full Review_____1. Project TitleTitle of Project:2. Date of IRB Approval:3. Principal Investigator InformationName:Home Address:Phone and Email PhoneEmail:Lourdes University Student Undergraduate GraduateName of Faculty Advisor:Project was for: Capstone Project Course Project Personal ScholarshipDate of Lourdes Graduation: Date: Degree Received:Lourdes Faculty or Staff Faculty Administration StaffLourdes DepartmentResearcher Affiliated with Institution:Other InstitutionDepartment4. Financial Support Lourdes University Other (Specify) Unsupported5. Project Closure Date:6. Completion of ResearchActivities (Check One) All research activities, including interaction with subjects, gatheringdata and analyzing data are complete. All data that could identify aparticular subject have been destroyed as outlined in the researchprotocol. Consent forms must be retained for 3 years, thendestroyed. For student researcher, the Faculty Advisor will retainthe consent forms for the 3 year period.The researcher is leaving Lourdes University and plans to continuethe research at another institution.Revised 6-20-12

Lourdes University Institutional Review BoardResearch Project Closure Form7. Provide an abstract of research findings8. List publications or presentations9. General observations about the effects of the research on the subjects (positive or negative.)10. Investigator Assurance: I verify that all research activities, including interaction with subjects,gathering data and analyzing data are complete. All data that could identify a particular subjecthave been destroyed as outlined in the research protocol. Consent forms must be retained for 3years, then destroyed.Investigator Signature: _____________________________________________ Date_________Faculty Advisor Signature:__________________________________________ Date_________For IRB Office Use OnlyClosure Form has been reviewed and accepted as submitted.Signature of IRB Reviewer:_____________________________________________Date__________Return Form to:Revised 6-20-12Lourdes University Institutional Review BoardIRB Mailbox, c/o Welcome Center,Russell J. Ebeid Hall (formerly McAlear Hall)6832 Convent Blvd.Sylvania, OH 43560