Reporting Form for Research Concerns or Complaints

May we reveal that you are the source of this concern or complaint to the study鈥檚 Principal Investigator and other study staff?
 

Personal Contact Information

(Required if you wish to hear back from us regarding this complaint)
 

PLEASE NOTE: Unless you authorize us to do so, your personal contact information will not be released to anyone outside of the Human Research Protection Program.


Are you making this report for someone else?

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Study Information

Please tell us about the study for which you have a concern or complaint

Have you discussed this concern or complaint with the Principal Investigator or other study staff?
Are you or the person you are submitting this form for a participant in this study?
(Please guess even if you can’t remember)
Are you still participating in the study?
Do you have a consent form for this study?
One file only.
6 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

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Maureen Owens
Director Human Research Protection Program
成人头条 University School of Medicine
1000 Oakland Drive
Kalamazoo, MI 49008
Office: 269.337.4269
Mobile: 616.808.9159

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