Institutional Review Board
Policy and Procedures

Informed Consent

If the project requires the use of written informed consent, the IRB suggests that researchers adapt, as appropriate, the following sample forms (MS Word format). Please avoid the use of jargon and technical terms, writing in lay language suited to an eighth grade reading level and using a font size large enough to enable the participants to read the form easily.

If you have any questions, please contact the Chair of the IRB: Dr. Kimberly Wear (336-841-9246)


Sample Consent Forms

Sample Consent Form Appropriate for Adults

Sample Consent Form Appropriate for Parent/Guardian Permission

Sample Consent Form Appropriate for Children





Contact Us

Chair of the IRB: Dr. Kimberly Wear
(336) 841-9246

For Students


Complete each section of the appropriate form (no handwritten forms). Email the form and any supporting documentation necessary to Signatures should be scanned and included as part of the electronic submission if possible.

Protocol Application
Exemption Checklist
Continuing Review Interim Report
Protocol Modification
Protocol Completion Report
Adverse Event
Informed Consent - Adult
Informed Consent - Child
Parental Permission
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