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Request: Fill out the attached IRB in compliance with my project requirements. I need the IRB approved as soon as posiable to conduct data collection during three months. Do not leave any blank. Ignore only any personal data, or data relevant to funding, coasts, or affiliated sites.Description of the request:I’m working on an applied research project ‘capstone” on a master level. The topic is “protocol to prepare senior adults with respiratory diseases for a dust storm”.My initial thoughts are to design protocol for doctors and nurses in Primary HealthCare Centers as well as health care providers who work on Home Health Care Services. The protocol is meant to educate their senior adult patients with respiratory issues about how and what to prepare for a dust storm. Once you ‘re done with filling out the IRB, I will open request another work on the capstone. πŸ™‚
study_pool_1.docx

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Research Proposal Application
IRB
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Date of application :
Registration No. :
Principal
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Name :
Investigator
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Position :
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Organization :
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Specialty :
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Mobile :
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E-Mail :
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Nationality :
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Chart Review
Human
Therapeutic
Diagnostic Laboratory
Basic Science
Personal Information
:
:(Please
check
all
applicable options)
Co-Investigators :
(Instructions: there is
no limit to the number
3
of
co-investigators
and their expertise
should
different
cover
the
research
areas).
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Type of Project :
Title
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Research :
of
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Other
PhD Project
Msc Project
Qualitative Rese
Quantitative Research
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Specialty of Research
:
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Primary Research :
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Basic
medical
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Secondary Research :
research
Type of Research :
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Clinical research
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Epidemiological
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Reviews
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Meta-analyses
research
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Health
Research
Themes :
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Biomedical Research
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Clinical Research
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Health Services Research
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Social, Cultural, Environmental, and Population Health Research
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Academic purpose – postgraduate degree
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Academic purpose – undergraduate degree
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Health Research Purpose for publication
Start Date :
Duration :
Purpose of Research :
βœ“ In MOH institutions
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Research Site :
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Research
Research
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Affiliation Name :
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Funding :
Out MOH institutions
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Both In & out MOH institutions
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One site
βœ“ Multi sites
Affiliation :
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Site
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Site
(Institution Name &
Reference
No.
if
available)
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Project Description :
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Project Achievements
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18. Background πŸ™ Instructions: Literature review of previous studies on the subject; and justification of
the study by stating the problem and its importance).
19. Objectives of the Study:
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Aim of the Study: (Instructions: state the goal you need to achieve)
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Specific Objectives: (Instructions: state the details of each objective that will finally lead to
achievement of the goal)
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Secondary Objectives: (Instructions: these are subsidiary objectives that could be studied
during the course of the project but are not the main objectives of the study, they are
optional and vary according to the type of the study).
20. Materials and Methods:(Instructions: Describe the research methods that could best achieve the
study objectives, recommend to attached flow charts)
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Study Area/Setting: (Instructions: describe the area or setting where the study will be
conducted. This description should cover the details relevant to the study topic)
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Study Subjects: (Instructions: Inclusion and exclusion criteria of the study subjects).
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Study Design πŸ™ Instructions: mention the type of study design eg cross-sectional, casecontrol, intervention study, etc…).
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Sample Size πŸ™ Instructions: mention the input criteria for sample size estimation).
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Sampling Technique πŸ™ Instructions: mention the sampling technique, (e.g. randomization)
that will be used in order to obtain a representative sample for your target population).
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Data Collection methods, instruments used, measurements (Instructions: Describe the
instruments used for data collection (questionaire, observation recording from, etc.), and
studied variables included in these instruments, as well as the methods used to test for the
validity and reliability of the instrument. Techniques used should be briefly described and
referenced. Study definitions [e.g., case definition] should be mentioned.
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Data Management and Analysis Plan: (Instruction: Describe the analysis plan, tests used for
data analysis and statistical package(s) used).
21. Bibliographic References:(Instructions: mention recent articles relevant to the study subject and
enumerated according to their order of appearance in the text).
22. Ethical Considerations: Informed Consent (Instructions: If needed, please attach Informed consent
and/or extra documents. Translated forms are provided when needed).
23. Benefits of The Research / Justification / Impact of the research on health services.
24. Work plan (Instructions: Please use this form as a template for the timeline of your project)
Task
Month
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2
3
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Progress
Report
25. Budget (Please use the attached documents for the price list of equipments used in the project if
applicable).
Budget Breakdown
Personnel
Unit Cost
Total
(SR)
(SR)
Remarks
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12
Supplies and Equipment
Patients Cost
Others
Grand Total
βœ“ Funds allocated to all personnel should not exceed 30% of the total budget, otherwise justification
letter should be included
βœ“ Unit cost of each task should be accurately given to allow proper budget evaluation.
26. Appendices: (Instructions: Data collection instruments, elaboration on methods and procedures to
be used, etc.) (Please attach the related documents) :
27. Principal Investigator’s Assurance:
While you submit this application through IRB committee e-mail, that is mean you agrees to accept
responsibility for the scientific and technical conduct of the proposed research and submission of
progress reports if this application is approved.

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