| ASENTRAL Institutional Review Board STUDY APPLICATION FORM (Note: application forms may be accessed from the Home Page and clicking on the FORMS button or by clicking on this link: FORMS) | |
| The Investigational Drug Brochure or Package Insert |
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| The Study Protocol (2 copies) |
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| The Informed Consent Form(s) (hard copy and electronic-Microsoft Word compatible) |
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| Proposed Subject Information (if any) |
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| Copy of the signed Form FDA 1572 or Investigator Statement |
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| Satellite Site Application(s) for each site listed in section #3 of the Form FDA 1572 (if applicable) |
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| Shipping and Invoicing Information Form |
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| Proposed Advertising/Recruitment material (if any) |
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| Any patient instructions, medical device user manuals, patient diaries or any other forms
designed to be used by patients during the study |
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| Curriculum vitae (CV) of the Principal Investigator and all Sub-Investigators (CV’s must
be current within 1 year, include any medical license information, research license information,
and be signed and dated). Massachusetts sites please include the Massachusetts Research Registration
Number from the Department of Public Health for the Principal Investigator The Board will send all original correspondence to the Principal Investigator. Upon written request, Asentral IRB will provide a copy of the approval documentation directly to the Sponsor/CRO/SMO managing the study. |