The University of Arizona

Forms Index

Report Misconduct

University Ethics and Compliance Hotline:


HSPP Contacts

Mariette Marsh, Director
(520) 626-7575

Andi Encinas, IRB Manager
(520) 626-8630

Liz Baldry, IRB Associate
(520) 626-0256

Mason Burchfield, IRB Associate
(520) 626-0433

Gina Fimbres, IRB Associate
(520) 626-0026

Christine Melton-Lopez, IRB Coordinator
(520) 626-5859

Courtney Olson, IRB Associate
(520) 626-1744

Darlene Villicana, IRB Associate
(520) 626-6282

Street Address
1618 E. Helen Street
Tucson, AZ 85721

Mailing Address
POB 210409
Tucson, AZ 85721


Customer Service Survey


Applications for Review

Determination of Human Research (Word)

F200: Application for Human Research (Word)

F203: Application for Retrospective Review of Data or Specimens (Word)

F204: Application for Ceded IRB Oversight (Word)

F299: Request for University of Arizona Human Research Site Authorization (Word


Appendix A: Children (Word)

Appendix B: Drugs and Devices (Word, PDF)

Appendix C: Multi-Site Research (Word)

Appendix D: Pregnant Women and Neonates (Word)

Appendix E: Prisoners (Word)

Appendix F: Waivers of Consent and Signatures or Alterations (Word)

Appendix G: Exceptions from Informed Consent (EFIC) (Word)

Appendix H: Native American or Indigenous Research (Word)


F212: Renewal Progress Report (Word)

F212B: Concluding/Admin Resolution (Word)

Amendments and Reportables

F109: Amendment of Key Personnel (Word)

F213: Amending Approved Human Research (Word)

F215: Minor Amendment of Approved Human Research (Word)

F216: Notify IRB (Word)

F224: Reportable New Information that is Potentially Problematic (Word)

Additional Forms

F107: Verification of Human Subjects Training (VOTF) (Word)

External Site Authorization (Word)

Institutional Certification for NIH Genomic Data Sharing (Word)

Consent Templates

T502a: Informed Consent Form Template (Word)

T503a: University of Arizona- Banner Health Consent Form Template (Word)

T502b: Addendum Template (Word)

T504a: PHI Authorization Form Template (Word)

C100: Elements of Consent (Word)

C101: Protected Health Information (PHI) Guidelines (Word)

Multi-Site Research   

Appendix C: Multi-Site Research (Word)

F213b: Amending Research for a Multi-Site (Word

F107b: Multi-Site List of Personnel (Word

F212c: Multi-Site Renewal Progress Report (Word

Individual Investigator Agreement (Word)

IRB Reliance Agreement – Ceding Review (Word)

IRB Reliance Agreement – UA Reviewing IRB (Word)

Humanitarian Use Devices

F221: Continuing Review Progress Report for Humanitarian Use Devise (HUD) (Word)

F222: Amendment of Approved Humanitarian Use Device (HUD) (Word)

C104: HUD Reponsibilities Checklist (Word)