Forms and Templates

Investigators are strongly encouraged to maintain electronic copies of all information (forms and files) submitted to the IRB. These electronic files will be needed in the event revisions are required after review.

Investigators must retain a hard copy or electronic version of the approved submission as well as the IRB's notification letters as part of the regulatory documentation.

Non-UMass Personnel List (HRP-215)

Use this form to report personnel outside the University of Massachusetts who are not listed in the eIRB system and who are not covered under their Institution's IRB.

Be sure the new staff fit a role described in the Investigator Study Plan. E-mail the Non-UMass Personnel list with the following to

  • Explanation of which staff are being added and/or deleted from an existing HRP-215 form
  • Copies of CITI Training Certificate(s) with UMass Worcester affiliation
  • Attestation that individuals are agents of UMass Worcester; for example, have gone through Volunteer Services or Human Resources, are paid by UMass Worcester, or are part of a recognized UMass program (e.g., Summer Undergraduate Research Opportunity). Or, a statement listing the person's home institution and whether or not an IRB Authorization Agreement is in place.
  • An evaluation of any positive declaration of a Related Financial Interest



Investigator Study Plan Template with Instructions

Use this template to develop the Investigator Study Plan. Instructions are included within the document.
Updated 12/8/15

Consent Form Template

Use this document to create the consent form for your research.
Updated 2/3/16

Assent Template

Use this document to create an assent form for children involved in research.
Updated 3/18/14

Fact Sheet Template

Use this document when the study is no more than minimal risk (e.g., simple blood draw, survey, focus group) and when you are requesting a waiver of written documentation of consent.
Updated 5/16/14

HIPAA Authorization



Use this document to obtain authorization to use /disclose PHI from participants of the research

Need some clarity on HIPAA Authorization/Waivers? Click here to see the presentation slides on "HIPAA and Research"

HIPAA Waiver

Use this form when requesting a waiver of HIPAA authorization

Authorization to Contact 

Complete this form if you would like someone to contact you about the Research

Short Forms: (English version)

Select the preferred form below when obtaining and documenting informed consent from subjects who do not speak English.

**Note: Non-English speaking subjects can only be enrolled into a Research Study if this is indicated in the approved Investigator Study Plan.



























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