school/home/field research site / non-regulated research site / regulated research site / work site / blood products / research / chemical concentrations / food / /
MedicalCondition
pain / injury / illness / /
Organization
Research Institution / Institutional Review Board / Institutional Animal Care and Use Committee / Regulated Research Institution / Institutional Biosafety Committee / Affiliate Fair Scientific Review Committee / /
Person
Designated Supervisor / Consent Form / /
Position
Supervisor and Qualified Scientist / Qualified Scientist / Printed Name SRC Chair / Supervisor / veterinarian / Team Member / Student/Team Leader / Principal Investigator / Approval State/National SRC Chair / researcher / Chair / Scientist / Qualified Scientist/Principal Investigator / Regional SRC Chair / /
Checklist for Adult Sponsor (1) This completed form is required for ALL projects. To be completed by the Adult Sponsor in collaboration with the student researcher(s): Student’s Name(s): Project Title: