IRB Project Review Form Instructions

Complete this form using Microsoft Word

You may use Microsoft Word to fill all requested information. Please DO NOT leave a question
blank. If a question does not apply to your research, please write N/A.

Prepare all necessary supporting documents and accompanying materials

1.

2.
3.

Documentation of consent procedures (one or more of the following must be provided):

a. Consent form(s)
b. Verbal Consent Script
c. Cover letter
d. Any survey instruments or questionnaires to be used
A list of interview questions or topics, in as much detail as possible (if interviews are used)
An electronic copy of NIH human subjects training workshop certificate for the Principal
Investigator and Faculty Mentor. NOTE: THIS POLICY WAS IMPLEMENTED ON

JULY 1, 2015.
4.

Any other supplementary materials specifically requested in this application form

Email this form and supporting documentation to the appropriate address

If you are a student Principal Investigator, email the entire application package to your faculty mentor /
research advisor for evaluation before IRB submission. After your faculty has reviewed and given consent
to your application and any documents (e.g. interview protocol, consent forms), you then email
irb@eastern.edu with your intent to submit. The IRB chair will enroll you in the IRB course site on
Brightspace. All email communication with the IRB must be from your secure EU email address.
Faculty applicants: Email the IRB (irb@eastern.edu) with your intent to submit and the name and email
address of either your dean or department chair. Once you have been enrolled in the course site on
Brightspace, you will be able to then submit all your documents via Brightspace.
Please note that, although most applications can be reviewed and approved simply with an electronic
signature, the IRB may, at its discretion, request submission of a signed hard copy. Whereas there is a
space for your signature, it is not required. Applying through the secure Brightspace course site serves as
your signature. All approvals will be sent as electronic emails, you can print that in case you need a hard
copy to show to the research site.

Review Timeline
When your packet has been received by the IRB, it will be checked for completeness. If not complete, you
will be requested to submit additional materials necessary for the review. Upon approval, you will receive
approval from the IRB by email. Do not begin collecting data until you receive this approval.

Exempt reviews will generally take no more than 10 business days to be reviewed.
Expedited reviews will take about 10 business days
Full Board reviews will be conducted at the next meeting of the IRB, provided that the
completed application has been received by the IRB at least 10 working days prior to the
scheduled meeting date. The IRB meets on a monthly basis during the fall/spring academic
semesters.
(June-August Exempt, Expedited and Full Board Reviews): Please note that the IRB board
does not review applications regularly during the summer months, so review times may take
longer (approximately 3-4 weeks). Applicants should plan appropriately for such potential
delays.

Contact Information
Website:
Mailing address:

http://www.eastern.edu/offices-and-centers/institutional-review-board
IRB, Eastern University
Phone: 610-341-4379
1300 Eagle Road
Email: irb@eastern.edu
St. Davids, PA 19087

PART I: Project Description

Principal Investigator(s) (PI):

(please list all names)

Caitlin Leffingwell

PI: Please attach an electronic copy of your (PI) NIH human subjects training certificate (NIH training link:
https://phrp.nihtraining.com/users/login.php)
See Appendix A

MAUS

Department:
Status:

Falls Center

Campus:

Faculty

Adjunct faculty

Faculty Mentor (if PI is a

student):

Staff

Undergraduate student

Graduate Student
Course Number:

Dr. J. Nathan Corbitt

URBN 580

Faculty Mentor: Please attach an electronic copy of your Faculty Mentors NIH human subjects training
certificate (NIH training link: https://phrp.nihtraining.com/users/login.php)
See Appendix A
E-mail:

cleffing@eastern.edu

Mail correspondence to:

Project Title:

(774) 287-1042

Fax:

49 Hungerford St (Floor 3), Hartford, CT 06106

Bridging Multicultural Communities through Musicking

Estimated Project Start

Date: (mm / dd / yyyy)

02/22/16

Is there, or will there be, extramural funding

that directly supports this research?
YES

Phone:

NO

Estimated Data Collection

Completion Date (Note: IRB approval
cannot exceed one year): (mm / dd /
yyyy)

4/03/16

Funding agency:
If yes:
PI on grant:

Are you conducting your study with Eastern University students?

YES
NO
If yes, and you plan to contact/use more than 100 students in your research, please seek permission from the Vice
President for Student Development and the Department of Institutional Review (please attach a document of
approval from the departments to this application).
Are you conducting your study off the premises of Eastern University such as an agency or school?
If yes, assurance of oversight by that entity must be provided to the IRB in the form of (please attach to application):
A letter of permission from the lead administrator (or his/her designee) to conduct the study, which shows evidence
that the administrator or official oversight group has reviewed the protocol and accepted its use at that institution
See Appendix B (attached)

IRB #:

(For Administrative Use Only)

ABSTRACT:
Briefly describe the purpose, research design, and procedures. Specify what the subjects will do:
The purpose of this study is to better understand how performing music together increases trust between people with
diverse cultural and socioeconomic backgrounds.
The participants in this study will include about 10 second grade violinists from St. Thomas the Apostle School
(called STA, a Catholic school in affluent West Hartford) and 10 second grade violinists from Milner Community
School (called Milner, a public school in the lowest income neighborhood of Hartford). Half of the students from
each school will be randomly assigned to Group A, which will act as a control group by interacting only through
activities unrelated to music. In contrast, the remaining students assigned to Group B will interact only through
activities related to learning and performing music together.
The study will take place over the course of about 6 weeks (late February through March). For the first three weeks,
students will interact only remotely through their shared violin instructor, with activities including pen pal letters
and shared art projects for Group A and recordings of rehearsals and favorite songs for Group B. This portion of the
study will take place at the students usual schools and during usual group classes. During the last three weeks, the
study will take place outside of regular class time; students from Group A will join each other for a local field trip
and game night, while students from Group B will attend a local performance and rehearsal together. These outings
will occur at neutral, easily accessible sites within the Hartford area. During the final week, all of the students and
their families will attend a final performance by Group B at the same local site that hosted their game night and
group rehearsal.
In addition to students signing assent forms, all participants' parents will sign consent forms that explain the study
and keep them updated on its progress. Students will be assessed every other week through child-friendly focus
groups and games designed to determine levels of trust between groups. All data will be kept confidential, and
randomized initials will be used to replace names in any public presentations.

Are there published articles/books/materials that affirm the safety and appropriateness of your methods? If so, list
them below (please use professional form when listing citations):
Are there published articles/books/materials that affirm the safety and appropriateness of your methods? If so, list
them
below
use professional
form whenapproaches
listing citations):
As
one
of the(please
most commonly
used qualitative
in professional fields like health and education, the
pragmatic philosophy that underlies this study inherently focuses on using the most sensible and practical methods
available in order to combine theory and practice in a way that offers concrete benefits to those involved (SavinBaden & Major, 2013, p.171). Moreover, its emphasis on observ[ing] human behavior and experiences as they
occurred in natural settings leads to minimal changes to participants daily lifeanother element that lowers
overall risk while maximizing benefits for participants (Savin-Baden & Major, 2013, p.170).
Savin-Baden, M., and Major, C. H. (2013) Qualitative research: the essential guide to theory and practice. New
York: Routledge.

PART II: What level of IRB review is needed for your project?
1.

2.

To determine whether your project is exempt from a full or expedited review by the IRB, please answer
the following questions. If you answered YES to any of these questions, then your project is NOT
exempt, and you should answer the questions in this section to determine whether your project
qualifies for expedited review.
Yes

No

1.

Yes

No

2.

Yes

No

3.

Yes

No

4.

Yes

No

5.

Are the subjects data directly or indirectly identifiable, and could these
data place subjects at risk (criminal or civil liability), or might they be
damaging to the subjects financial standing, employability, or reputation?
Will subjects be asked to report their own or others sexual experiences,
alcohol or drug use, and will you know their identities?
Are subjects used who may not be legally competent (under 18 years old,
or subjects with certain conditions of intellectual, emotional or
developmental disability?)
Are personal records (medical, academic, etc.) used with identifiers and
without written consent?
Are any subjects confined in a correctional or detention facility?

Yes

No

6.

Will alcohol or drugs be administered?

Yes

No

7.

Will blood/body fluids be drawn?

Yes

No

8.

Will specimens obtained from an autopsy be used?

Yes

No

9.

Will you be including pregnant women by design?

Yes

No

10. Are live fetuses subjects in this research?

Yes

No

11. Will Non-English speakers be included?

Yes

No

12. Will economically or educationally disadvantaged populations be targeted?

Yes

No

13. Will members from minority groups be targeted?

If you answered YES to any of the questions above, please do not check anything here and proceed to
the Expedited Review Criteria Section (p. 6). If you answered NO to all of the questions above, then
your research qualifies for exempt review IF it fits into at least one of the following categories. Please
check all that apply:
Educational Research
Research in established or commonly accepted educational settings, involving normal educational
practices. This is for research that is concerned with improving educational practice.

Surveys, Questionnaires, Interviews, or Observation of Public Behavior

The subject matter must not involve sensitive topics, such as criminal or sexual behavior, alcohol or
drug use on the part of the subjects, unless they are conducted in a manner that guarantees
anonymity for the subjects

Surveys, Questionnaires, Interviews or Observation of Public Behavior

Surveys that involve sensitive information and subjects identities are known to the researcher may
still be exempt if: (1) the subjects are elected to appointed candidates for public office; or (2) federal
statute(s) specify without exception that confidentiality will be maintained throughout the research and
thereafter.

Archival Research
Research involving the collection or study of existing data, documents, records, pathological or
diagnostic specimens, if these sources are publicly available or if the information is recorded by the

investigator in such a manner that subjects cannot be identified, directly or through identifiers linked to
the subjects. These data/samples must be preexisting, which means they were collected prior to the
current project.

Research Examining Public Benefit or Public Service Programs

To qualify for this exemption, the research must also be conducted by (or subject to review by) an
authorized representative of the program in question. Studies in this category are still exempt if they
include pregnant women by design and their purpose is to examine benefit programs specifically for
pregnant women.

Taste Evaluation Research

Studies of taste and food quality evaluation. Studies of taste evaluation qualify for this exemption only
if
(1) wholesome foods without additives are consumed; or (2) a food is consumed that contains a food
additive present at or below the level that has been found to be safe.

Noneducational/Other Research involving Special Consideration Populations (e.g.,

persons who are not legally competent, emotionally, cognitively or developmentally disabled
populations, non-English speakers, economically or educationally disadvantaged populations,
members from minority groups)
To qualify for exemption, the research must pose no more than minimal risk to subjects. The federal
definition of minimal risk is: The probability and magnitude of harm or discsomfort anticipated in the
research are not greater in and of themselves than those ordinarily encountered in daily life or during
the performance of routine physical or psychological examinations or tests.

If you determined that your project is exempt from expedited or full board review, then please
proceed to page 7, Part III. Data Collection Procedures. Otherwise, please answer the following
questions to determine whether your project qualifies for expedited review.

Expedited Review Criteria

1.

To meet expedited review criteria, your project must meet the following conditions:

No more than minimal risk to the subjects

i. The federal definition of minimal risk is: The probability and magnitude of harm or discomfort
anticipated in the research are not greater in and of themselves than those ordinarily
encountered in daily life or during the performance of routine physical or psychological
examinations or tests.

2.

Subjects must not be confined in a correctional or detention facility

Subjects must be participating in one or more of the ways described in the following section
(see #2).

Your project qualifies for expedited review IF subjects are participating in one or more of the
following ways. Please check all that apply.
Collection of excreta and external secretions
This includes sweat, saliva, placenta, and/or amniotic fluid. None of these may be collected by
invasive procedures, such as those that use cannulae or hypodermic needles, such as
amniocentesis.

Recording of data using noninvasive procedures routinely employed in clinical practice.

This includes but is not limited to the use of contact recording electrodes, weighing, tests of sensory
acuity, electrocardiography and electroencephalography, and measure of naturally occurring
radioactivity.
IMPORTANT EXCLUSIONS: This does NOT include procedures which: (a) impart matter or
significant amounts of energy to the subjects; (b) invade the subjects privacy; or (c) expose subjects
to significant amounts of energy outside the visible range (e.g. ultraviolet light from tanning beds).

Collection of hair or nail clippings, or teeth from patients whose care requires the
extraction or collection of plaque and/or calculus
Collection of dental material must use routine procedures for the cleaning of teeth.

Voice recordings
Recordings made for research purposes such as the investigation of speech defects and speech
pathology.

Moderate exercise
Moderate exercise performed by healthy volunteers.

Experimental procedures (i.e., manipulation of an independent variable)

Research performed to investigate individual or group behavior or the characteristics of individuals,
such as studies of perception, cognition, game theory, or test development.
IMPORTANT EXCLUSIONS: This does NOT include studies that (a) involve significant stress to the
subjects or (b) that are intended to produce a relatively lasting change in behavior.

Educational research with subjects under 18 years of age

Research in established or commonly accepted educational settings, involving normal educational
practices and involving subjects are under 18 years of age. This is for research that is concerned with
improving educational practice.

Studies of archived data, records or diagnostic specimens

This category would include studies of these specimens that do not qualify for exempt review.

Collection of blood samples

Studies involving the collection of blood samples by venipuncture, in amounts not exceeding 550 mL

(about one pint) in an eight-week period and no more than two times per week, from subjects 18
years of age or older and who are in good health and not pregnant.

If your study fits into one or more of the nine types of participation and meets the required criteria, then
your project can receive EXPEDITED REVIEW from the IRB. If your study does not meet expedited
review criteria, then it qualifies for FULL BOARD review. The IRB will determine which level of review is
appropriate for your project, based upon the information you provide in this form.

Full Board Reviews

Research projects that require full board review have the potential for more than minimal risks (physical,
psychological, or social) to subjects and/or include populations with special considerations (including
research on prisoners, persons who are not legally competent, emotionally, cognitively or developmentally
disabled populations).

The IRB will determine which level of review is appropriate for your project, based upon the
information you provide in this form.

PART III: Data Collection Procedures

1.

Please indicate the method(s) to be used: (check all that apply)

Investigator

Survey administered by:

Subject

Mail

Phone

In Person

Internet / E-mail

Please submit a copy of the survey that you will use. See Appendix C
One-on-one

Focus Group

Oral History

Other (specify):

Interview
Please submit a copy of the interview questions that you will use. See Appendix C
Observation of Public Behavior
Archived Data or Records
Taste or Sensory Evaluation

Classroom
Academic

Public Setting

Medical

Food Tasting

Legal

Other (specify):

Olfactory

Therapeutic Evaluation

Biomedical

Psychological

Physical Therapy

Experimental Procedures

Biomedical

Psychological

Other (specify):

Examination of Pathological or Diagnostic Tissue Specimens

Other (briefly describe):

Other (specify):

2.

Please indicate how the data will be handled: (see the IRB manual, p. 45)
Anonymous
1.

Confidential

Intentionally identified

What form of consent will be obtained? (refer to the Informed Consent Form Guidelines
document)

Written (please attach consent form). If you are not using written consent please provide
rationale and then select the type of consent below:
See Appendix D and Appendix E
Implied
Verbal

(please attach cover letter or describe terms on a separate page)

(please attach consent script)

Seeking Waiver of Consent

Consent Not Applicable
2.

(please contact IRB for further information)

(please explain reasons on a separate page)

If the data will be handled in an anonymous or confidential manner, how will confidentiality be
maintained? (please check all that apply)
Anonymous is defined as: data are recorded such that no identifier whatsoever exists to link a
subjects identity to that subjects response. No one can link an individual person to the response of
that person, including the investigator(s). Face-to-face interviews and data collection are never
anonymous.
Confidential is defined as: there exists a documented linkage between a subjects identify and
her/his response in the research. The investigator provides assurance in the protocol and in the
informed consent that the identity of any individual subject will not be revealed in any report of the
study. Confidentiality means that the investigator can (or could) identify individuals who
participated in a study, perhaps through a code.

Coded to a master list and separated from the data

Stored in a locked cabinet
Stored in a locked office
Stored in a restricted (password-protected) computer
Other (specify):
3.

Who will have access to the data?

Caitlin Leffingwell (primary investigator)

4.

Will any of the following be collected? Please check yes or no for each of these 3 categories
below
Yes
Yes
Yes

No
No
No

Video recordings (either tape or digital)

Audio recordings (either tape or digital)
Photographs

5.

If you answered YES to any of the above in Question 4, then please provide the following
information:
Where will the recordings or photographs be stored?
On a password-protected device, specifically designated for this project only and accessible only by the P.I.

When (approximate date) will this material be destroyed? This should also be included in the
consent form.
06/01/2017

How will confidentiality be maintained?

Each student will be assigned a distinct set of randomized initials upon signing up for this study, and only the P.I. will
know which initials correlate to which student. Similarly, recordings and photographs will be stored on a device
accessible only to the P.I., who will immediately label them with aforementioned initialsnever any actual names. As
such, all publications will use these initials rather than true names.

PART IV: Description of the Population

16

Approximate age range:

7-9

1.

Approximate number of subjects:

2.

How will subjects be selected or recruited, and how will subjects be approached (or contacted)?
The families of current 2nd graders from two separate violin programs (taught by the same teacher, who is also the PI) will all
be sent informational invitations, and students who are willing and able to participate for the entire duration of the study will
ultimately be selected for the project. These invitations will include a full explanation of what the project will entail and hopes
to accomplish, and participants parents or guardians must sign the attached informational consent form in order for their
children to participate. Participating students will also sign an assent form as well, following a brief introduction to the project.
Initial contact with families will take place in person after respective group classes, with forms emailed or handed out
according to the needs of parents.

3.

Will subjects be compensated (including extra credit*)?

Yes
No
If yes, then please explain how much, when, and how they will be compensated, and explain whether they
must complete the project in order to be paid.
Although not planning on a need for compensation, there is a possibility that some participants may only be able to sign up
and participate consistently with some form of compensationprimarily in the form of gas money reimbursement. As such,
parents would be given $20 gift cards to local gas stations once they have completed the project with full attendance.

*If extra credit is to be given, please explain how students who do not participate may earn extra credit
through alternative means.
N/A

4.

Are any subjects under 18 years of age?

Yes

No

If yes, both parents must give their permission unless one parent is deceased, unknown, incompetent,
or not reasonably available, or when only one parent has legal responsibility for the care and custody
of the child. Please provide a copy of the parental consent form with the IRB application. (See
Appendix D)

If yes, does the proposed research include children between the ages of 8 and 17 years old? An assent
form should be used for subjects who are 8 to 17 years old. Please provide a copy of the minor assent
form with the IRB application. (See Appendix E)
5.

Are any subjects not legally competent to give consent?

If yes, then please explain how consent will be obtained. Who will give consent on
their behalf? What procedures will be followed? Please attach consent form.

Yes

No

Yes

No

Parents or guardians of students will receive full information regarding the project, and will then
be asked to sign a written consent form if interested in allowing their child to participate.
Although some participants may not have two parents available, all reasonable efforts will be
made to gain consent from both parents/guardians. All families involved can speak English.

6.

Will any minority groups be excluded from the study pool?

If yes, then please justify the exclusion.

7.

Will any minority groups be targeted in this study?

Yes
If yes, please provide justification for targeting minority groups.

No

One of the two communities involved is predominantly comprised of families from the West Indies, Africa,
or Puerto Rico. Although not targeted for these specific ethnicities, the purpose of this project is to explore
relationship catalysts and the benefits thereof between communities with very different cultural and
socioeconomic backgroundsmaking this population an incredibly important part of the research, as well
as one with much to gain from increased social (bridging) capital.
Specify how risks are minimized for this population.
Every effort (and then some) will be made to honor, respect, and empower the members of this community
based on cultural competence training and research regarding cultural norms, societal sore spots, and
spiritual truth. Great care will be taken throughout the entire project to navigate potential tensions,
conflicts, or negative effects in a way that benefits this community in particular. A school counselor is also
available at both schools to support students if needed.
8.

Is this study likely to involve any subjects who are not fluent in English?
Yes
If yes, please submit both English and translated versions of consent forms and surveys,
if applicable. Please ensure that the translations are accurate.

No

9.

Does this study involve subjects located outside of the United States?
Yes
If yes, please explain on an attached page exactly who the subjects are and the identities
(if possible) and responsibilities of any additional investigators.

No

10. Does this study involve economically or educationally disadvantaged populations?

Yes
No
If yes, please provide justification for including/targeting economically or educationally disadvantaged
populations.
The same participants who comprise the minority population in this project are also predominantly
economically disadvantaged, in that they come from one of the lowest-income neighborhoods in Hartford.
Because the purpose of this project is partly to determine ways of increasing social justice and righting
societal imbalances, these participants can help shed light on this subject in invaluable ways that could
potential even benefit them the most.
Specify how risks are minimized for this population.
See answer to 7b.

10

PART V: Use of Deception

If any deception is required for the validity of this activity, explain why this is necessary. Please also
include a description of when and how subjects will be debriefed regarding the deception, and attach a
debriefing script.
N/A

PART VI: Risks and Benefits

1.

Describe any potential risks to the subjects, and describe how you will minimize these risks. These
include stress, discomfort, social risks (e.g., embarrassment), legal risks, invasion of privacy, and side
effects.
Although very minimal risk is anticipated in this study (due primarily to the fact that it entails activities the participants are
already involved in through school and after-school programming), the cross-cultural nature of the additional interactions
could create socially tense situations if issues of race and socioeconomic status arise. Such issues could create some
embarrassment, conflict, confusion, and sensitivity. In order to minimize these risks, the PI will set clear behavior boundaries
centered around respect, and each class will end with a debrief time for students (and families, if desired) to have a safe
space for discussing challenging topics or concerns. Transparency will be maintained throughout the entire project as well,
such that participants always understand what happened, what is happening, and what will happen as much as possible.
Furthermore, a school counselor is available at both schools to provide support as well, and families are told from the
beginning that they can remove their children from the study at any point.

2.

In the event that any of these potential risks occur, how will the situation be handled (e.g.,
compensation, counseling, etc.)?
As previously noted, time and space will be set aside after each interaction between the groups, so that any individual or
family who wishes to debrief regarding challenging events or responses can do so. These debriefs will start with the PI, but
can be referred to more applicable professionals if necessary. A school counselor is available at both schools, and Milner has
multiple social workers on staff. Similarly, the PI will remain very open and responsive to concerns from participants and their
families, and no one is required to continue throughout the entire project if they decide it is not best for them.

3.

11

Will this study interfere with any subjects normal routine?

Yes

No

4.

Describe the expected benefits to the individual subjects and those for society. This is required
information.
By examining how musicking can build trust between two very diverse urban communities, the aim of this
pilot project is to combine theory and practice in a way that draws rightful and active attention to an important
tool for improving our society. It will not only provide additional musical training and life skills to
participants, but also expand their world view and foster meaningful relationships with a diverse group of
peers. Moreover, forming connections with members from different communities is an important part of the
bridging social capital so lacking in low socioeconomic areas specifically, such that members of this
community may also benefit even more from access to expanded resources and increased quality of life.

5.

If blood or other biological specimens will be collected, then please address the following:
N/A

a.

Brief description of sampled tissues:

b.

Describe the personnel involved and procedure(s) for obtaining the specimen(s). Please note that IRB
requires that only trained certified or licensed persons may draw blood. Contact IRB for more
information.
N/A

PART VII: Use of Collected Data

Please check all that apply:
Thesis / Dissertation
Journal Article / Publication
Grant Activities
Other (briefly describe):

PART VIII: Drug or Alcohol Consumption

Note: If your project is exempt from expedited or full board review, then you may skip this
section and proceed to Part IX on the next page.
1.

Will any Investigational New Drug (IND) or any other substance regulated by the
Food and Drug Administration (FDA) be used?
Yes
No
If yes, then please note that the Eastern University IRB is not able to provide approval
or oversight for your project. In order to conduct research involving Investigational
New Drugs (INDs) or other substances subject to FDA regulation, you will need to work
with a collaborator affiliated with another institution whose IRB is able to provide the
review and oversight required by federal regulations.

2.

Will alcohol be ingested by the subjects?

Yes
No
If yes, then please describe what type and how it will be administered.
N/A

12

PART X: Assurances signatures needed only if submitting hard copy

This investigation involves the use of human subjects. I understand Eastern Universitys policy concerning research
involving human subjects and I agree to:
1.

Obtain voluntary and informed consent of persons who will participate in this study, as a required by the
Eastern University Institutional Review Board (IRB).

2.

Report to the Eastern University IRB any adverse effects on subjects which become apparent during the
course of, or as a result of, the activities of the investigators.

3.

Cooperate with members of the IRB who are responsible to review this project, and to give project reports as
required by the IRB.

4.

Obtain prior approval from the IRB before amending or altering the project or before implementing changes
to the approved consent form.

5.

Maintain documentation of IRB approval, consent forms and/or procedures, together with the data, for at
least three years after the project has been completed.

6.

Treat human subjects in the manner specified on this form.

Principal Investigator: The information provided in this form is accurate, and the project will be conducted in accordance with
the above assurances.

Signature

Caitlin Leffingwell

Print Name

Caitlin Leffingwell

Date

11/23/15

Principal Investigator

Signature

Print Name

Date

Print Name

Date

Principal Investigator

Signature
Principal Investigator

Faculty Sponsor (if PI is a student): The information provided in this form is accurate, and the project will be conducted in
accordance with the above assurances.

Signature

Print Name

Dr. J. Nathan
Corbitt

Date

11/23/15

Faculty Sponsor (if P.I. is a student)

Chair, Director, or Dean: This project will be conducted in accordance with the above assurances.

Signature

Print Name

Dr. J. Nathan
Corbitt

Date

11/23/15

Chair, Director, or Dean

Please Note:

The IRB approval is effective for only one year. After that, an extension request must be
submitted before you can continue your project.

Institutional Review Board Approval: These assurances are acceptable, and this project has adequate protections
for the subjects. This project has been properly documented and reviewed and is in compliance with federal,
state, and university regulations.
Signature__________________________________ Print Name_______________________ Date_____________
Signature__________________________________ Print Name_______________________ Date_____________

Eastern University IRB use ONLY:

Review Status of Protocol:

13

Exempt

Expedited

Full Board

Appendix A: NIH Training Certificates

PI: Caitlin Leffingwell
Faculty Mentor: Dr. Nathan Corbitt

14

Appendix B: Letters of Permission

Milner Community School Administrator: Takeia Pitts (Program Director)

15

St. Thomas the Apostle School Administrator: Colleen DiSanto (Principal)

16

Appendix C: Survey
Part 1:
Administered (verbally or written) by the P.I. at the first group class of the study.
Name: ____________________
Age: _____________________
Gender: __________________
Ethnicity (check all that apply):

White
Hispanic or Latino
Black or African American
Native American or American Indian
Asian / Pacific Islander
Other

Language(s) spoken fluently: ______________________________________

Current City/Town: _____________________________
Previous City/Town(s): __________________________
Part 2:
Administered (verbally or written) by the P.I. during Week 1, Week 4, and Week 8.
In general, do you agree or disagree with the following statements?
Strongly
agree
People can be trusted
If I needed help, most people
would help me
People think about themselves
before thinking about others
I trust people in my community
Most people in my community
will try to take advantage of
others
People in my community trust
each other
People in my community are not
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Agree

Neutral

Disagree

Strongly
disagree

willing to help if needed

I feel safe around people in my
community
I trust people from other
communities
I trust people who speak a
different language than me
I trust people of other cultures
I trust people from my culture
I trust government officials
I trust teachers
I trust law enforcers
I trust shopkeepers
I trust nurses and doctors
I trust strangers
I trust churches
Others can trust me
If I could help someone else, I
would
I need to look out for myself first,
before helping others
I would lend one of my toys to
someone from a different
community
It is good to be around people
who are different from me
I get along with people from
different cultures

Part 3:
The Trust Game will be administered by the P.I. during every group class. After learning
that their donation will be doubled for the other group, students must decide as a group
how many tokens to give to the other group. Upon receiving this donation, the other
group then has a turn to decide how many tokens to return to the other group.
During the final rehearsal, students will be able to buy prizes with their tokens, thereby
giving them value. This activity will be used to measure levels of trust between groups
over time, as well as to build relationships between the two classes.

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Appendix D: Research Study Parent Consent Form

*Red text applies only to families from Milner Community School, in order to offset
varying degrees of access*
Study Title: Bridging Multicultural Communities through Musicking
Researcher: Caitlin Leffingwell, Masters in Urban Studies Program,
cleffing@eastern.edu, (774) 287-1042
Introduction: Your child is being asked to take part in a research study carried out by
Caitlin Leffingwell, a graduate student at Eastern University in the Department of Urban
Studies. This form explains the research study and your childs part in it if s/he decides to
join the study. Review this consent form thoroughly. Ask the researcher to explain
anything you dont understand. You may also contact the Institutional Review Board at
IRB@eastern.edu. If your child chooses to join the study, s/he may change his/her mind
and withdraw at any time. This study has been reviewed for approval for human subject
participation by the Eastern University Institutional Review Board.
What does this study address?
The purpose of this study is to better understand how performing music increases trust
and social capital between people with diverse cultural and socioeconomic backgrounds.
Participants will engage in a variety of activities over the course of about 8 weeks, which
will begin with non-music related activities and segue into learning, rehearsing, and
performing music together for friends and families. Throughout the course of this project,
levels of trust between each group will be evaluated through questionnaires and games
designed based on current research on Social Capital Theory and inclusive cultural
citizenship. These evaluations will increase our understanding of the unique role that
musickingor the act of performing togethercan increase trust between even diverse
groups and thereby increase social capital and the benefits thereof for everyone involved.
What is required of participants in this study?
Attendance at regular group classes for the duration of the study (approx. 2/22/16
to 4/3/16).
Attendance at one group rehearsal and one group performance outside of school
hours and school grounds (time and location determined based on neutrality,
accessibility, and availability). Friends and family will be invited to the final
performance. Milner students will be provided transportation if needed.
Willingness to interact respectfully with students from different cultural and
socioeconomic backgrounds
Sharing written and recorded communication with other studentsall under the
direct supervision of the primary investigator
Permission to be photographed and/or videotaped
Permission to publish participant statements and imagesmaintaining their
anonymity

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Verbal and/or written assessment every other week during group classes, which
focus on determining levels of trust between groups and in general
Providing responses that represent authentic opinions
Engagement in critical analysis of your experience and the program

How does my child benefit from this study?

Developing additional musical repertoire and important life skills
Increased cultural awareness and competence through exposure to diverse
perspectives
A unique learning experience provided at no cost to participants
Increased quality of life through mutually beneficial social connections
Contributing to practical research that could significantly impact the quality of
our societystarting in your own community
What are the risks of participating in this study?
Social discomfort while working with diverse individuals
Logistical challenges for final rehearsal and performance
Difficult conversations stemming from new experiences and interactions
Uneasiness from existing norms being challenged
Is there any compensation for this study?
Families who could not otherwise participate can request transportation stipend
or expense reimbursement.
During the final rehearsal, all students will be able to exchange tokens shared
throughout the project for small prizes
Audio/Video Recording and Photographs
Throughout the project, students will have opportunities to communicate through
video recordings and pictures taken and shared during class. These recordings will
always be in the sole possession and control of the principal investigator, and they
will only be shared to students in her presence.
Recordings and photos may be included in published material, but will have no
personal identifiers attached.
Recordings and photos will be stored on a secure device and will be destroyed by
June 1, 2017.
Participants will not be guaranteed rights to inspect, approve, or receive
compensation for usage of recordings or photos.
Please sign below if you are willing to allow your child to be recorded (video and still
pictures). He or she may still participate in this study if not.
I do not want my student to be recorded during class.
I am willing to allow my student to be recorded during class:
Signed: _________________________________ Date: _________________

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How is confidentiality maintained?

While participants will not be anonymous in the context of interactions with one
another, all published responses from their assessments will use randomized
initials rather than any real names.
Published statements and/or images will not be associated with names or any
other information that can be used for identification.
Participant Bill of Rights
The rights below are the rights of every person who is asked to be in a study. In
participating as a human subject, I have the following rights:
1. To be told what the study is trying to find out;
2. To be told what will happen to me and whether any of the procedures, drugs or
devices are different from what would be used in standard practice;
3. To be told about the frequent and/or important risks, side effects or discomforts of
the things that will happen to me for research purpose;
4. To be told if I can expect any benefit from participating, and, if so, what the
benefits might be;
5. To be told of the other choices I have and how they may be better or worse than
being in the study;
6. To be allowed to ask any questions concerning the study both before agreeing to
be involved and during the course of the study;
This research has been reviewed and approved by the Eastern University Institutional
Review Board. If you have any questions, regarding the terms of participation in these
study, please contact the researcher or review board at irb@eastern.edu.
Thank you for your time,

Caitlin Leffingwell, clef356@gmail.com, (774) 287-1042

Consent Statement
I have read the above statements and agree to participate in the study according to terms
outlined above.
Your child's name: _____________________________________
Your signature: ________________________________________ Date _____________
Your printed name: _____________________________________ Date _____________
Signature of person obtaining consent: ______________________ Date _____________
Printed name of person obtaining consent: ___________________ Date _____________

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Appendix E: Child Assent Form

We are doing a study to learn about how different activities help people become friends
even if they come from different cultures and different places.
If you agree to be in our study, we are going to ask you to interact with students from a
different school by sending them notes, pictures, crafts, and even videos. They will send
back similar activities, and we will continue sharing new experiences during group class
for about two months. Every other week, we will also play a game and have a discussion
that helps us understand how much we trust each other.
You can ask questions about this study at any time. If you decide at any time not to
finish, you can decide not to continue.
The questions we will ask are only about what you think. There are no right or wrong
answers because this is not a test.
If you sign this paper, it means that you have read this and that you want to be in the
study. If you dont want to be in the study, dont sign this paper. Being in the study is up
to you, and no one will be upset if you dont sign this paper or if you change your mind
later.
Your signature: _____________________________________ Date _____________
Your printed name: __________________________________ Date _____________
Signature of person obtaining consent____________________ Date _____________
Name of person obtaining consent_______________________ Date _____________

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