STUDY ID # (for ERB office use only)

FINAL REPORT

Project Title:
Principal Investigator (PI):
PI Email:	PI Phone:
PI Department:
Student Researcher:	Student Email:
Class or Degree Program:	Student Phone:
Co-Investigator:	Co-Investigator Email
Co-Investigator Department:	Co-Investigator Phone:

add more lines for additional co-investigators, student investigators, or other study staff, as necessary

The Final Report must be submitted to the ERB within four weeks of project end.

1. Date project closed: __________________________

2. Reason for closing project: (e.g., unable to enroll participants, project not funded, project completed)

3. Have all research activities been concluded, including data analysis? Yes No

If “No”, then the study cannot be terminated and ERB continuing review approval is required (see ERB website for ERB Continuing Review form).

4. Total number of participants approved for the study: _________

5. Final enrollment numbers

Number of subjects who consented (enrolled): __________

Number of enrolled subjects who withdrew: ____________

Number of enrolled subjects withdrawn by the PI: ___________

Number of enrolled subjects who completed the study: _____________

6. Were you able to recruit participants in the ethnic, racial and/or gender categories indicated in your proposal? Yes No. If not, why? (explain below) Not applicable

7. Have there been any participant complaints since the last review?

Yes. If yes, describe complaint and resolution in the space below.

No

8. Have there been any breaches of participant confidentiality since the last review?

Yes. If yes, note whether this was previously reported to the ERB and describe breach and resolution in the space below.

No

9. Have any unexpected risks, problems, or adverse events been encountered since the last review?

Yes. If yes, note whether this was previously reported to the ERB and describe in detail in the space below.

No

10. Include the following documents as attachments to this application:

Brief summary of the study progress to date.

Citation list of any related papers, abstracts, presentations, etc. from this study.

By signing below, I/we certify that the information contained in this application is accurate and complete, and understand that submission of this final report closes ERB approval for this study and no further research activities will take place.

Principal Investigator Signature_________________________________________ Date______________

Student Researcher Signature __________________________________________ Date______________

Co-Investigator Signature _____________________________________________ Date______________

add more signature lines for additional co-investigators or student investigators, as necessary. signatures of study staff are not necessary; only principal/co-investigators and student researchers must sign erb forms.