IRB Proposal
Page 1 of 12 APPLICATION FORM – INITIAL REVIEW INSTITUTIONAL REVIEW BOARD Room 117 Main Building 555 Broadway Dobbs Ferry NY 10522 mcirb@mercy.edu MC IRB Protocol No.: Date of IRB Review: For office use only PROJECT TITLE Good Gig Jobs or Bad Gig Jobs? The Impact of Sharing Economy W ork on Career Trajectory PRINCIPAL INVESTIGATOR Name (Last, First) Degree(s) Campus Phone Number Ravenelle, Alexandrea Ph.D. 914-674-7341 Department Campus Mailing Address Connec t/Mercy E-mail Address Social and Behavioral Science 555 Broadway, Dobbs Ferry, NY 10522 aravenelle@mercy.edu FACULTY SPONSOR Name (Last, First) Degree(s) Campus Phone Number Ravenelle, Alexandrea Ph.D. 914-674-7341 Department Campus Mailing Address Mercy E-mail Address Social and Behavioral Science 555 Broadway, Dobbs Ferry, NY 10522 aravenelle@mercy.edu List all co-investigators below, including those from other insti tutions STUDENT-INVESTIGATOR Name (Last, First) Phone # Connect E-mail Address Mailing Address STUDENT-INVESTIGATOR Name (Last, First) Phon e # Connect E-mail Address Mailing Address STUDENT-INVESTIGATOR Name (Last, First) Phon e # Connect E-mail Address Mailing Address STUDENT-INVESTIGATOR Name (Last, First) Phon e # Connect E-mail Address Mailing Address Page 1 of 12 APPLICATION FORM – INITIAL REVIEW INSTITUTIONAL REVIEW BOARD Room 117 Main Building 555 Broadway Dobbs Ferry NY 10522 mcirb@mercy.edu MC IRB Protocol No.: Date of IRB Review: For office use only PROJECT TITLE Good Gig Jobs or Bad Gig Jobs? The Impact of Sharing Economy W ork on Career Trajectory PRINCIPAL INVESTIGATOR Name (Last, First) Degree(s) Campus Phone Number Ravenelle, Alexandrea Ph.D. 914-674-7341 Department Campus Mailing Address Connec t/Mercy E-mail Address Social and Behavioral Science 555 Broadway, Dobbs Ferry, NY 10522 aravenelle@mercy.edu FACULTY SPONSOR Name (Last, First) Degree(s) Campus Phone Number Ravenelle, Alexandrea Ph.D. 914-674-7341 Department Campus Mailing Address Mercy E-mail Address Social and Behavioral Science 555 Broadway, Dobbs Ferry, NY 10522 aravenelle@mercy.edu List all co-investigators below, including those from other insti tutions STUDENT-INVESTIGATOR Name (Last, First) Phone # Connect E-mail Address Mailing Address STUDENT-INVESTIGATOR Name (Last, First) Phon e # Connect E-mail Address Mailing Address STUDENT-INVESTIGATOR Name (Last, First) Phon e # Connect E-mail Address Mailing Address STUDENT-INVESTIGATOR Name (Last, First) Phon e # Connect E-mail Address Mailing Address Page 1 of 12 APPLICATION FORM – INITIAL REVIEW INSTITUTIONAL REVIEW BOARD Room 117 Main Building 555 Broadway Dobbs Ferry NY 10522 mcirb@mercy.edu MC IRB Protocol No.: Date of IRB Review: For office use only PROJECT TITLE Good Gig Jobs or Bad Gig Jobs? The Impact of Sharing Economy W ork on Career Trajectory PRINCIPAL INVESTIGATOR Name (Last, First) Degree(s) Campus Phone Number Ravenelle, Alexandrea Ph.D. 914-674-7341 Department Campus Mailing Address Connec t/Mercy E-mail Address Social and Behavioral Science 555 Broadway, Dobbs Ferry, NY 10522 aravenelle@mercy.edu FACULTY SPONSOR Name (Last, First) Degree(s) Campus Phone Number Ravenelle, Alexandrea Ph.D. 914-674-7341 Department Campus Mailing Address Mercy E-mail Address Social and Behavioral Science 555 Broadway, Dobbs Ferry, NY 10522 aravenelle@mercy.edu List all co-investigators below, including those from other insti tutions STUDENT-INVESTIGATOR Name (Last, First) Phone # Connect E-mail Address Mailing Address STUDENT-INVESTIGATOR Name (Last, First) Phon e # Connect E-mail Address Mailing Address STUDENT-INVESTIGATOR Name (Last, First) Phon e # Connect E-mail Address Mailing Address STUDENT-INVESTIGATOR Name (Last, First) Phon e # Connect E-mail Address Mailing Address Page 1 of 12 APPLICATION FORM – INITIAL REVIEW INSTITUTIONAL REVIEW BOARD Room 117 Main Building 555 Broadway Dobbs Ferry NY 10522 mcirb@mercy.edu MC IRB Protocol No.: Date of IRB Review: For office use only PROJECT TITLE Good Gig Jobs or Bad Gig Jobs? The Impact of Sharing Economy W ork on Career Trajectory PRINCIPAL INVESTIGATOR Name (Last, First) Degree(s) Campus Phone Number Ravenelle, Alexandrea Ph.D. 914-674-7341 Department Campus Mailing Address Connec t/Mercy E-mail Address Social and Behavioral Science 555 Broadway, Dobbs Ferry, NY 10522 aravenelle@mercy.edu FACULTY SPONSOR Name (Last, First) Degree(s) Campus Phone Number Ravenelle, Alexandrea Ph.D. 914-674-7341 Department Campus Mailing Address Mercy E-mail Address Social and Behavioral Science 555 Broadway, Dobbs Ferry, NY 10522 aravenelle@mercy.edu List all co-investigators below, including those from other insti tutions STUDENT-INVESTIGATOR Name (Last, First) Phone # Connect E-mail Address Mailing Address STUDENT-INVESTIGATOR Name (Last, First) Phon e # Connect E-mail Address Mailing Address STUDENT-INVESTIGATOR Name (Last, First) Phon e # Connect E-mail Address Mailing Address STUDENT-INVESTIGATOR Name (Last, First) Phon e # Connect E-mail Address Mailing Address Page 1 of 12 APPLICATION FORM – INITIAL REVIEW INSTITUTIONAL REVIEW BOARD Room 117 Main Building 555 Broadway Dobbs Ferry NY 10522 mcirb@mercy.edu MC IRB Protocol No.: Date of IRB Review: For office use only PROJECT TITLE Good Gig Jobs or Bad Gig Jobs? The Impact of Sharing Economy W ork on Career Trajectory PRINCIPAL INVESTIGATOR Name (Last, First) Degree(s) Campus Phone Number Ravenelle, Alexandrea Ph.D. 914-674-7341 Department Campus Mailing Address Connec t/Mercy E-mail Address Social and Behavioral Science 555 Broadway, Dobbs Ferry, NY 10522 aravenelle@mercy.edu FACULTY SPONSOR Name (Last, First) Degree(s) Campus Phone Number Ravenelle, Alexandrea Ph.D. 914-674-7341 Department Campus Mailing Address Mercy E-mail Address Social and Behavioral Science 555 Broadway, Dobbs Ferry, NY 10522 aravenelle@mercy.edu List all co-investigators below, including those from other insti tutions STUDENT-INVESTIGATOR Name (Last, First) Phone # Connect E-mail Address Mailing Address STUDENT-INVESTIGATOR Name (Last, First) Phon e # Connect E-mail Address Mailing Address STUDENT-INVESTIGATOR Name (Last, First) Phon e # Connect E-mail Address Mailing Address STUDENT-INVESTIGATOR Name (Last, First) Phon e # Connect E-mail Address Mailing Address MC IRB Application Form – Initial Review Page 2 of 12 Check the proposed research category: Category I (Administrative Review) Email the application packet to MCIRB@mercy.edu Category II (Expedited Review) Email the application packet to MCIRB@mercy.edu Category III (Full Review) Email the application packet to MCIRB@mercy.edu FUNDING SOURCES Check all of the appropriate boxes for funding sources for t his research. Include pending funding source(s). Federal Grant Faculty Development Grant Personal Funds Department Gift Commercial – company name : X Other : Labor Research Action Network (LRAN) Grant, (received) If federally funded, provide name and address of individual to whom certification of IRB approval should be sent: Name Address line 1 Address line 2 City, State, Zip Attach the research proposal/protocol that was sent to the agency , committee, or sponsor for peer-review of scientific merit if applicable. DATA COLLECTION OR COLLABORATING SITES If the participants are to be recruited from an instituti on or organization (e.g., hospital, social service agency, prison, school, etc.) or from a privately owned business (p rivate practice, local sports gym, etc.), documentation of permission from the institution must be submitted to the committee before final approval can be given. Letters of permission (on organizatio n’s letterhead) from a senior office of the institution, organization, or business should authorize t he investigator(s) to contact potential participants, to use the facilities, or access the records of th at entity.