Faculty Supervisor's Statement

TO:        Institutional Review Board for the Protection of Human Subjects

FROM:  Faculty Supervisor:

             Department of:

             Telephone Extension:

NAME OF STUDENT:

TITLE OF THESIS OR PROJECT:

SPONSOR'S STATEMENT: It is recommended that in completing this form the faculty sponsor begin with (1) a succinct statement of the risks, followed by (2) a brief description of the measures to be taken against these risks, and (3) a brief statement which places the research methodology within the broader context of similar research in the discipline. Please make sure that you (4) explain how the student's proposed study complies with (a) Federal regulations and (b) University policy with regard to protection of human subjects from potential harms or risk and (c) with respect to the principles of justice, beneficence, and respect for persons.(see "Dear Colleague" Letter of 01/22/01 for additional guidance.)

My signature below certifies that I as Faculty Sponsor of this research have read and approve the attached application.

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Thesis Chair / Research Supervisor Signature and Date