IRB Forms and Templates


Template Documents

To access the IRBmanager portal, please email
with your name and department name so an account can be created
for you. Once you receive an email confirmation with login instructions,
please click here to access the IRBmanager portal.


Miscellaneous Forms

Enrollment Report Use this form for initial submissions and progress reports to indicate the target/actual enrollment of each ethnic category for your site
Data Use Agreement for Research For use with a limited data set Updated 5/28/14
Optional Authorization for Research Contact Use this form to obtain optional authorization to contact patients about future research studies
External Site Questionnaire Submit this form if an external site wants to rely on Northwell Health for IRB review  Updated 1/23/15
Application for Approval of International Research Submit this form if you plan to conduct research internationally
Application for an Umbrella Grant Submit this form for administrative review of an Umbrella Grant

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