Listserv Research Checklist, 2016

1
Listserv Research Checklist
Date:__
Title of Project: 
Investigators
1. SIP MEMBER (either PI, researcher or consultant): n/a
2. Principle Investigator: 
a. Native: ___Yes,  ___ No    Not stated
i. If yes go to question 6    ,
ii.  If no go to question 5
b. Student: __ Yes, ___ No
i. If yes go to question 3
ii. If no go to question 4 and/or 5
3. Student Researcher: 
4. Researcher on project: 
5. Native Consultant if PI or Student PI are not Native: 
6. Contact information for PI: 
2
A. Institutional Review Board
1. Contact Information of IRB
a. Included   __________________
b. Not Included ________________
2. IRB Submission which should include the methods and permissions of tribes if 
specific tribes are listed in methods.
a. Tribal membership required___ Yes, ___No
i. If yes, are letters from tribes included? _____ Yes, ___ No.
ii. If no, REJECT _______________
3. IRB Approval Number: 
B. Dissemination Plan
a. Clearly stated dissemination plan ___ Yes, ___ No
b. Includes a Journal of Indigenous Research publishable summary for 
Submission
___ Yes, ___ No
c. Clear plan for storage of data: ___ Yes, ___ No
Decision:
____ Approve for listserv
____ Approve for listserv if _________
____ DO NOT approve for listserv