SAMPLE Human subjects Training Module Form

I.D. Number:

OTHR-WR-PR-041

Your last name:

SMITHINS

Your first initial:

D

Your e-mail:

smithd00@umail.ucsb.edu

Your sponsor's e-mail

lunsford@writing.ucsb.edu (optional)

Last name of I.D. number owner:

WRITPROG

Other notification:

facultyname@writing.ucsb.edu (optional: instr.'s name)

Have you ever logged in with this I.D. before?

yes no