IBC Screening Form for Clinical Trials - Environment, Health and Safety

To request Institutional Biosafety Committee (IBC) review for a clinical trial, please complete the IBC screening form below. Once submitted, the IBC coordinator will reach out to the study coordinator and principal investigator with further instructions within one to three business days of the screening form’s submission.

Study Title(Required)

Principal Investigator(Required)

First Last

Principal Investigator Email(Required)

Enter Email Confirm Email

Principal Investigator Phone(Required)

Study Contact(Required)

First Last

Study Contact Email(Required)

Enter Email Confirm Email

Study Contact Phone(Required)

Is this an industry or commercially sponsored study?(Required)

(ex. Moderna, Pfizer, etc.)

Who is the study's sponsor?(Required)

Is this study funded by a grant and/or federally funded?(Required)

(ex. NIH, NIAID, etc.)

What is the name of the granting and/or funding agency?(Required)

Is this considered a Phase 1 "first-in-kind" clinical trial involving a new/novel therapeutic?(Required)

Does the study involve expanded access of an Investigational New Drug for a single patient?(Required)

Please provide a brief description of the Investigational Product.(Required)

Please attach the Investigator's Brochure and/or Pharmacy Manual (if available)

Drop files here or

Max. file size: 98 MB.