DATE
DATE
PI NAME:
STUDY TITLE:
IRB NUMBER:
The attached translated document titled, “” is an accurate interpretation of the English version dated .
I am a and assure the University of Utah Institutional Review Board that that this translation is accurate to the best of my knowledge.
I also assure the University of Utah IRB that I am acting independently from the principal investigator, and am not affiliated with this study in any way.
If you have any questions, please contact me using the information below.
Phone:
Fax:
Email:
Thank you,
________________________________
Signature of Translator/Reviewer
________________________________
Printed Name of Translator/Reviewer
................
................
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