ࡱ> ')&q L bjbjt+t+ *AA7]2222222FFFF8~ F r t t t t t t $  j 2 22   22r FF2222r  %V& @22r  ZkgFFjf Protocol Completion/Termination Report Institutional Review Board (IRB) Principal Investigator: IRB Protocol #: Email Address: Phone Number: Extension: Project Title: Protocol Results: 1. Provide a brief description of the results obtained by this study (use additional pages as needed): 2. Have any articles been published using the results of this study? ( Yes ( No 3. Number of articles/manuscripts submitted or in development: 4. Total number of subjects enrolled in study: Total number of subjects completing study: 5. Did any adverse events (AE) occur? ( Yes ( No If yes, how many? ______________ Were all adverse events (AEs) reported? ( Yes ( No 6. Please check any/all reasons applicable for protocol completion/termination request (check at least one): ( PI completed goals of study ( Protocol did not receive funding ( PI or co-PI no longer resides at institution ( Student PI has graduated ( Data analysis continuing; no further contact with study participants ( Investigator lost interest in pursuing study ( Protocol closed due to adverse event ( Other: PI Certification: I certify, as of the date below, human subjects are no longer being studied, contacted or enrolled in the protocol listed above. Therefore, this protocol should be officially designated as completed/terminated by the IRB. ____________________________ _______________ Signature of Principal Investigator Date ___________________________________ ___________________ __________________ Signature of Supervising Faculty Member Department Date ________________________________________________________________________________________________________________________________ FOR IRB USE ONLY: Date Received: ______________ Revised 6/30/2005 ab+,-?@FG,-VW2 3 ` a j k l ~  b c } ~     6 7 I L CJ jCJCJCJCJCJCJG'Hab +,-?@$00$d%d&d'd$00$d%d&d'd$00$00$d%d&d'd000000'Hab +,-?@FGw%O+ Y j k l ~  b c & } ~   7 I J K L =FGw%O+ Y j k l ~ $00$d%d&d'd0$00$d%d&d'd~  b c & } ~   7 I J K L  |0 !D%$000||00$d%d&d'd$00$d%d&d'd(&P/ =!"#$%@ [$@$NormalmH @@ Heading 1$$8@&CJTT Heading 2+$$00$d%d&d'd@&CJ<A@<Default Paragraph Font*>@*Title$5CJ0J@0Subtitle$5CJPT@P Block Text%$00$d%d&d'dCJ,",Header  !, @2,Footer  !LL ~ L L 8@0(  B S  ?7JMx _G_7JMCSU3C:\TEMP\AutoRecovery save of AdverseEventReport.asdCSU3C:\TEMP\AutoRecovery save of AdverseEventReport.asdCSU3C:\TEMP\AutoRecovery save of AdverseEventReport.asdCSU,C:\WINDOWS\Desktop\IRBAdverseEventReport.docCSU6C:\TEMP\AutoRecovery save of IRBAdverseEventReport.asdCSU*C:\WINDOWS\Desktop\IRBCompletionReport.docCSU4C:\TEMP\AutoRecovery save of IRBCompletionReport.asdCSU*C:\WINDOWS\Desktop\IRBCompletionReport.docCSU*C:\WINDOWS\Desktop\IRBCompletionReport.docCSU*C:\WINDOWS\Desktop\IRBCompletionReport.docRN% mzvx>Pf --OJQJo( OJQJo(o(.z>RN% @,,D',,,,L@@GTimes New Roman5Symbol3& ArialEMonotype Sorts"hfƅf 0!20dQInitial Review ApplicationCSUCSU Oh+'0   < H T `lt|Initial Review ApplicationnitSUSU Normal.doti5UMicrosoft Word 8.0i@vA@ }@ }@wgg0 ՜.+,D՜.+,` hp  pQ1 Initial Review Application Title 6> _PID_GUIDAN{6DD43569-B754-11D9-9676-000476E87EBF}  !"#$%(Root Entry FGC }@ckg*1TableWordDocument*SummaryInformation(DocumentSummaryInformation8CompObjjObjectPool@ckg@ckg  FMicrosoft Word Document MSWordDocWord.Document.89q