Uab Department Of Psychology Scientific Review Form Page 3
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4For Psychology Chair’s Office
Date Received in Chair’s Office:_______________
Date Returned to PI:_____________
UAB Department of Psychology Scientific Review Form
(Must be included with all protocol submissions to the UAB IRB)
The Principal Investigator identifies at least one scientist, who is not a co-investigator or supervisor on the project, to
review the research protocol and provide comments and/or suggestions prior to IRB submission. Results of the review(s)
should be attached to this form for departmental review and IRB submission.
(Based on UAB Notice of IRB Submission Policy Change Dated June 3, 2003)
Project Title:_______________________________________________________________________________
Principal Investigator:
__________________________________________________________
(please print or type)
Doctoral Program (for graduate students; BN, LDPP, or MDPY): ____________
Exempt
Expedited
Full
New Submission
Renewal with Significant Changes
This protocol has been reviewed at the
Departmental Level
External Reviewer(s) [outside the department]
Reviewing Scientist(s): The following individuals have provided comments and suggestions to the Principal
Investigator on this project:
________________________________
________________________
________________
Name
Title/Affiliation
Date of Review
(Print or Type)
________________________________
________________________
________________
Name
Title/Affiliation
Date of Review
(Print or Type)
I have received and addressed all comments and recommendations from the reviewer(s).
_____________________________________
_____________________
Principal Investigator Signature
Date
This project is approved by the Department of Psychology for submission to the UAB-Institutional
Review Board for formal institutional review.
_________________________________________________
_____________________
Mary Frances Thetford, M.Ed.
Date
Executive Program Director, Psychology
_________________________________________________
_____________________
Karlene K. Ball, Ph.D.
Date
University Professor and Chair, Department of Psychology
Rev. 3/26/2013
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