This application is for (check one):
E-mail address of principal investigator (student name if student lead research):
Telephone:
Project Title:
This project is being concluded as (check one):
Faculty Supervisor email address:
Telephone:
Course Title (if appropriate):
Department:
Course No.:
This project is being funded by (if applicable):
DIRECTIONS
In considering applications, the committee will want to see the following issues
addressed in a brief (e.g., 1-2 page) statement attached to this Application.
The Committee's general concern is the safety and well being (both physical and
psychological) of human subjects in research. Failure to answer all questions
can result in the proposal being returned to you for further information. Please
allow at least two weeks for review. A member of the Review Committee will contact
you with a decision in writing. Do no collect data prior to this time. The application
number you will be given must appear on all documents such as survey forms, reports,
and summaries related to this research project. Please type/computer print your
responses.
1.) What is the purpose of the study? Please provide a brief description of
the hypothesis and issues under consideration.
2.) What subject group(s) will you work with, and how will you recruit them?
3.) What information will you offer subjects about your study before they
participate? (E.g., how will the study be described, what incentives will
be offered?) Except in special circumstances (which you must describe and
justify), potential subjects should be given enough information about the
project to make an informed decision about whether or not to participate.
Subjects should not be coerced or pressured, and should be told that they
are free to withdraw from participation at any time.
4.) Does the study involve children or others for whom additional consent
will be necessary? If so, how will you obtain this consent? (Note: Research
involving children normally requires written permission from parents or guardians,
in addition to written permission from a school principal or other institutional
director, if applicable. Describe how you will seek this permission, attaching
copies of proposed permission/consent forms where appropriate.)
5.) How will you plan to protect the privacy and/or anonymity of your subjects,
and the anonymity of the data at the conclusion of the study? Please specify
how you will destroy the data. If you do not intend to destroy the data, how
will it be stored and protected?
6.) Does the study involve deception? If so, explain why deception is necessary
and how you will address any potentially harmful consequences.
7.) What are you experimental procedures? Are there any potentially harmful
effects that might occur in your study? If so, what are they, and how will
you guard against them or seek to minimize them?
8.) If appropriate, how will you debrief your subjects after their work is
completed?
9.) Please attach a copy of any survey, questionnaire and/or consent form(s)
you plan to use.