IRB Application Example

MONTANA STATE UNIVERSITY
Request for Designation of Research as Exempt
MSSE Research Projects Only
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THIS AREA IS FOR INSTITUTIONAL REVIEW BOARD USE ONLY. DO NOT WRITE IN THIS AREA.
Confirmation Date:
Application Number:
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DATE of SUBMISSION: November 3, 2011
Address each section – do not leave any section blank.
I. INVESTIGATOR:
Name: Henry MSSE Jones
Home or School Mailing Address: 2566 Oak Street, Bozeman, MT 59718
Telephone Number: 406-555-1111
E-Mail Address: [email protected]
DATE TRAINING COMPLETED: March 8, 2011 [Required training: CITI training; see website for link]
Investigator Signature ____Henry MSSE Jones
Name of Project Advisor: John Graves
E-Mail Address of Project Advisor: [email protected]
II. TITLE OF RESEARCH PROJECT:
The Effects of Incorporating Technology into Science Instruction at
th
the 7 Grade Level
III. BRIEF DESCRIPTION OF RESEARCH METHODS (If using a survey/questionnaire, provide a copy). I will
be incorporating technology into teaching practices and assessing whether or not the new technology
encourages independent learning, content mastery, and increased interactions with peers, parents, and
teachers. Please see attached for copies of data collection instruments.
IV.
V.
RISKS AND INCONVENIENCES TO SUBJECTS:
SUBJECTS:
A. Expected numbers of subjects: 62
B. Will research involve minors (age <18 years)?
Yes
No
(If 'Yes', please specify and justify.) This will be in a classroom setting – 7th Grade middle
Schoolers and they are between the ages of 12 and 13yrs.
C. Will research involve prisoners?
Yes
No
D. Will research involve any specific ethnic, racial, religious, etc. groups of people?
(If 'Yes', please specify and justify.)
Yes No
VI.
FOR RESEARCH INVOLVING SURVEYS OR QUESTIONNAIRES:
(Be sure to indicate on each instrument, survey or questionnaire that participation is voluntary.)
A. Is information being collected about:
Sexual behavior?
Yes
Criminal behavior?
Yes
Alcohol or substance abuse?
Yes
Matters affecting employment?
Yes
Matters relating to civil litigation? Yes
No
No
No
No
No
B. Will the information obtained be completely anonymous, with no identifying information linked to the
responding subjects?
Yes No
C. If identifying information will be linked to the responding subjects, how will the subjects be
identified? (Please circle or bold your answers)
By name
Yes No
By code
Yes No
By other identifying information
Yes No
D. Does this survey utilize a standardized and/or validated survey tool/questionnaire?
Yes
No
VII. FOR RESEARCH BEING CONDUCTED IN A CLASSROOM SETTING INVOLVING NORMAL EDUCATIONAL
PRACTICES:
A. This research project must be approved by your Principal or School Administrator, unless there are
circumstances or policies that do not make this possible. Please provide a copy of this approval. If
such approval is not possible, please explain.
B. Participation of your students in research must be voluntary and can never affect their rights.
Please make this issue clear on all of your research surveys (use introductory text, see below) and/or
interviews (use introductory verbal statement, see below). The following wording or something similar
can be used for the introductory text or statement: Participation in this research is voluntary and
participation or non-participation will not affect a student’s grades or class standing in any way.
C. Extra credit should not be used to encourage participation. If you absolutely need to use extra
credit, then an alternative activity involving the same amount of time and effort must be provided for
those who choose not to participate. This must be clearly described in your IRB application.
E. Depending on your school policies, consent forms may or may not be required for your research.
Please indicate whether you will be using consent forms or not. If you are not using consent forms,
please justify (e.g., school policy, etc.). If you do use consent forms, you must include signature lines
for parental consent AND student assent. (Please use accepted format from our website and provide
a stand-alone copy. Do not include form here.) I am sending as a separate attachment both
forms: Exemption form and Administrator Sign off form.
Pre-Treatment Questionnaire
Participation in this research is voluntary and participation or non-participation will not affect a student’s grades
or class standing in any way.
1. How often do you spend time outside of school looking up information or reading about information related
to your science lessons?
Never 1
Hardly Ever 2
Sometimes 3
Often 4
All the Time 5
2. How often do you talk to your parents or ask your parents questions about information related to your
science lessons?
Never 1
Hardly Ever 2
Sometimes 3
Often 4
All the Time 5
3. How often do your parents ask you questions or approach you about science related homework or
information related to your science classes?
Never 1
Hardly Ever 2
Sometimes 3
Often 4
All the Time 5
4. How often do you do extra work related to studying for or preparing for quizzes and tests?
Never 1
Hardly Ever 2
Sometimes 3
Often 4
All the Time 5
5. How often do you contact your friends outside of class to ask questions about your science homework or for
assistance from them in any way related to your science homework?
Never 1
Hardly Ever 2
Sometimes 3
Often 4
All the Time 5
6. How often do you use the Bozeman Middle School Mr. Jones’s Web Pages to review material we have
covered in class, or to watch animations or simulations related to class?
Never 1
Hardly Ever 2
Student Attitudes And Experiences with Learning Science
Start of 7th grade
Directions: The statements in this survey have to do with your opinions and beliefs about science instruction in
school and the importance of science in your life. Please read each statement carefully, and circle the number
that best expresses your own feeling.
TECHNOLOGY USE REFLECTION
Participation in this research is voluntary and participation or non-participation will not affect a student’s grades
or class standing in any way.
Please write a few things that made it beneficial to learn using tools of technology at home or in school. Also,
please note any difficulties you encountered.
Which technological
tools did you use in the
Following three units?
home school
Geology (Earth)
iPad
iPod Touch
Laptop
Desktop Computer
Smart Phone
Geology (Oceanography)
iPad
iPod Touch
Laptop
Desktop Computer
Smart Phone
Geology (Stream Science)
iPad
iPod Touch
Laptop
Desktop Computer
Smart Phone


Benefits of use
Problems with use
a. Please write two or more examples of something you learned while using technology (that may have been
difficult understanding without it).
b. Is there anything that you think that I could do, or could have done differently to improve your learning
experience?
c. Is there anything that you think that YOU could do, or could have done differently to improve your learning
experience?