Forms & Templates

Name Description
Assent Form for Adults with Cognitive Impairments Assent form for adults with cognitive impairments. Please NOTE: this is NOT a consent form. This form is for people working with adults who have cognitive impairments such that they cannot sign a consent form themselves, and will need to get consent from that person's caretaker, parent, guardian, etc.
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Assent Form for Children aged 7-12 Use this form when children aged 7-12 are a subject research population, the regulations require the assent of the child or minor and the permission of the parent(s), in place of the consent of the subjects.
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Assent Form for Older Children/Young Adults Aged 13+ Use this form when minors aged 13+ are a subject population in the research project, the regulations require the assent of the child or minor and the permission of the parent(s), in place of the consent of the subjects. Please note that age of majority in MA is 18 but that this varies by state.
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Baystate and UMass Collaborative Human Subjects Form Use this form when researchers from UMass Amherst are collaborating in human subject research with researchers at Baystate Medical Center.
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Counseling Resources Guidance Provides guidance on counseling resources for studies on sensitive topics. May be edited as necessary, making sure all contact information relevant to the specific study is accurate and up-to-date.
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Debriefing Form - Deception Guidance on how to ameliorate the effects of unavoidable deception in a research study, the IRB requires debriefing of the deceived subjects.
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Debriefing Form - General Form may be used as a handout to debrief participants on any aspect of a research study considered sensitive.
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Determination of Human Subject Research Form Provide information in Kuali to help HRPO determine whether your project requires IRB review. Please note that HRPO makes the determination whether or not a project meets the definition of human subject research.
HIPAA Authorization Template Use this form to request access to Health Insurance Portability and Accountability Act (HIPAA) data from individuals.
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Informed Consent Template - Complex Biomedical - Revised Use this template for complex biomedical research which may necessitate several visits by participants and more than one intervention.
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Informed Consent Template - Focus Group - Revised The consent template to be used when research involves focus groups.
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Informed Consent Template - General - Revised Use this template to compose the Informed Consent document. Instructions specific to items on the form are included in brackets.
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Informed Consent Template - iDXA Use this template if your research involves iDXA.
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Informed Consent Template - International Affective Picture System (IAPS) - Revised Use this template when utilizing an International Affective Picture System (IAPS) image set. IAPS contains images meant to elicit an emotional response from the research participant. Images are categorized as pleasant, neutral or unpleasant.
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Informed Consent Template - Magnetic Resonance Imaging (MRI) - Revised Use this template if your study uses Magnetic Resonance Imaging.
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Informed Consent Template - Muscle Biopsy - Revised Use this template if your study includes muscle biopsies.
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Informed Consent Template - Online Survey - Revised Use this template if your study involves an online survey research component.
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Informed Consent Template - Paper Survey Consent Paragraph You may use this template if you're conducting a paper survey and are requesting a waiver of documentation of informed consent.
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Informed Consent Template - Sensitive Topics - Revised Use this template for research that involves topics which may be considered sensitive.
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Informed Consent Template - Short Version of Written Consent The oral and short verision of the written consent form is designed to provide a mechanism for individuals with limited English language proficiency to participate in human subject research where their lack of proficiency would otherwise be a barrier to their participation.
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Informed Consent Template - Subject Recruitment Database Use this template if researcher will be asking participants to be part of a subject recruitment database.
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Informed Consent Template - Video Use - Revised Informed Consent form to use for research involving video or audio recordings.
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Informed Consent Template - VO2 Max - Revised Use this template if your study uses V02 Max.
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PAR-Q Screener Script Short script to read before issuing the PAR-Q as a screener.
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Parent Permission for Minor to Participate in Research - Revised Use this form to have parents give permission for their child to participate in research.
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Recruitment Database Application Form Use this application form to establish a subject recruitment database.
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Reviewer Checklist for Amendments Reviewer Checklist for IRB Members to document their review and analysis of Full Board protocols reviewed by the convened IRB. The Reviewer Checklist helps ensure that all required elements of the federal criteria for approval are met.
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Reviewer Checklist for Continuing Review This checklist helps reviewers structure the continuing review of approved protocols and maintain consistency in the process.
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Reviewer Checklist for New Protocols This checklist helps reviewers conduct a review of new protocols and maintain consistency in the process.
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Reviewer Checklist for Renew/Amends Reviewer Checklist for IRB Members to document their review and analysis of Full Board protocols reviewed by the convened IRB. The Reviewer Checklist helps ensure that all required elements of the federal criteria for approval are met.
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