Application To The Institutional Review Board For The Protection Of Human Subjects Page 4

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7. Mentally disabled subjects will be used
Yes
No
8. Prisoners and/or incarcerated subjects will be
used
Yes
No
If you have answered YES to any of Section B items 1
9.
through 8, a Consent Form must be included as a part of
this application.
a.
Please review the information available at:
b.
Please see the form called “Elements of Consent”, and use the
form called “Consent Form template” to develop a consent form.
Note:
c.
Informed consent must be given by either the research
subject or by his/her legally authorized representative, such as a
parent or guardian.
10. Subjects will be compensated
Yes
No
If yes, clarify in what form: ___________________________
11. If you are using one of the protected class subjects (minors, mentally
retarded, prisoners, etc.) how will you insure that they be able to give
voluntary and informed consent?
4

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