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1、IRBTemplateRev.Date:9-1-12IRBUseOnly–DoNotReviseorDeleteVCUIRBSTUDYPERSONNELROSTER(forExpeditedandFullBoardResearch)PrincipalInvestigator:vcuemail:ResearchCoordinator:vcuemail:vcuirb#:TitleofProject:STUDYPERSONNELROSTERINSTRUCTIONS:?Definitionsanddetailedinstructionsforformcompletion
2、andsubmissionarelocatedattheendofthisform.Pleasereviewtheinstructionscarefullybeforecompleting,revising,orsubmittingthisform.STUDYPERSONNELROSTERFirstNameLastNameCOIInvestigator**Non-VCUAffiliate-COIPolicyAdherence(SeeInstructions)***RoleinStudy-(entryshouldmatchinformationonStudyPer
3、sonnelInformationandChangeForm)DateAdditionProposedtoIRB:DateRemovalProposedtoIRB:YESNOVCUPolicyNon-VCUAffiliate’sInstitutionalPolicy1)IfOther,list:2)IfOther,list:3)IfOther,list:4)IfOther,list:5)IfOther,list:6)IfOther,list:7)IfOther,list:8)IfOther,list:9)IfOther,list:10)IfOther,list:
4、11)IfOther,list:12)IfOther,list:13)IfOther,list:14)IfOther,list:15)IfOther,list:16)IfOther,list:17)IfOther,list:18)IfOther,list:19)IfOther,list:20)IfOther,list:Page6IRBTemplateRev.Date:9-1-12IRBUseOnly–DoNotReviseorDeleteRosterVersionDate:(Insertupdatedversiondate)Page6IRBTemplateRev
5、.Date:9-1-12IRBUseOnly–DoNotReviseorDeleteSTUDYPERSONNELROSTER–CONTINUATIONPAGE(ifneeded)FirstNameLastNameCOIInvestigator**Non-VCUAffiliate-COIPolicyAdherence(SeeInstructions)***RoleinStudy-(entryshouldmatchinformationonStudyPersonnelInformationandChangeForm)DateAdditionProposedtoIRB
6、:DateRemovalProposedtoIRB:YESNOVCUPolicyNon-VCUAffiliate’sInstitutionalPolicy1)IfOther,list:2)IfOther,list:3)IfOther,list:4)IfOther,list:5)IfOther,list:6)IfOther,list:7)IfOther,list:8)IfOther,list:9)IfOther,list:10)IfOther,list:11)IfOther,list:12)IfOther,list:13)IfOther,list:14)IfOth
7、er,list:15)IfOther,list:16)IfOther,list:17)IfOther,list:18)IfOther,list:19)IfOther,list:20)IfOther,list:21)IfOther,list:22)IfOther,list:23)IfOther,list:24)IfOther,list:25)IfOther,list:26)IfOther,list:27)IfOther,list:28)IfOther,list:Page6IRBTemplateRev.Date:9-1-12IRBUseOnly–DoNotRevis
8、eorDelete1)I
