Forms & Templates

Thank you for visiting the Human Research Protection Program Forms Page! Please note that many of our forms are protected documents. In order to allow for typing into the requested fields, you will want to "Save As" and save our document to a folder on your hard drive. If you find that you continue to have problems filling out our forms, please contact us at irb@purdue.edu. Thank you!

*All forms must be typewritten.

Exemption Request Forms Form
Category 1 - Research conducted in educational settings, involving normal educational practices MSWORD
Category 2 - Research involving the use of educational tests, survey procedures, interview procedures or observation of public behavior MSWORD
Category 3 - Research using category 2 study procedures that is not exempt under Category 2 IF: (see Category 3 description by clicking on the title above) MSWORD
Category 4 - Research involving the collection or study of existing data, documents, records, pathological or diagnostic specimens MSWORD
Category 5
Research and demonstration projects conducted by or subject to the approval of U.S. Department or Agency heads, and which are designed to study, evaluate, or otherwise examine:
  • public benefit (e.g., financial or medical benefits as provided by Social Security) or service programs (e.g., social, supportive or nutrition services as provided under the Older Americans Act);
  • procedures for obtaining benefits or services under those programs;
  • possible changes in methods or alternatives to those programs or procedures; or
  • possible changes in methods or levels or payment for benefits or services under those programs.
If you feel your research meets the criteria for category 5, please contact the IRB.
Category 6 - Taste and food quality evaluation and consumer acceptance studies MSWORD
Non-Exempt Research Application Forms for Expedited or Full Review Form
Application Form MSWORD
Amendments to Approved Studies Form
Amendment to Approved Study MSWORD
Personnel Amendment to Study MSWORD
Consent/Assent Templates Form
  • The Consent Form and Assent Form include special instructions in orange italics
  • Replace italics on form as needed (Tab key will not navigate through)
Consent Form (template only) MSWORD
Consent Form Template with Guidance MSWORD
Sample Assent Form MSWORD
Guidance on writing Consent Forms by reading level ADOBE-PDF
Unanticipated Problem/Adverse Event Reporting Form
Reporting Form MSWORD
Decision Tree MSWORD
HIPAA Forms Form
Authorization for Release of PHI (Non-Purdue Covered Entities) MSWORD
Authorization for Release of PHI (Purdue Components) MSWORD
Request for Waiver of Authorization or Modification of Authorization MSWORD
Activities Preparatory to Research Waiver MSWORD
Use of Decedent's Information Certification MSWORD
Data Use Agreement MSWORD
HIPAA Disclosure Tracking Form MSWORD
Worksheets Form
Worksheet - Determination of Human Subjects Research MSWORD
Checklist for IRB Submissions Form
  • Investigators have developed these Research Tracking Forms which we have posted for your convenience
  • If you find these forms helpful, use them.
Research Group Management Checklist MSWORD
Subjects Management Checklist MSWORD
Miscellaneous Forms Form
Participant Payment Disclosure Form MSWORD
Confidentiality Agreement Form
Confidentiality Agreement Form MSWORD

Purdue University, West Lafayette, IN 47907 (765) 494-4600

© 2014 Purdue University | An equal access/equal opportunity university | Copyright Complaints | Maintained by Office of the Executive Vice President for Research and Partnerships

If you have trouble accessing this page because of a disability, please contact Office of the Executive Vice President for Research and Partnerships at evprp@purdue.edu.