HUMAN ETHICS COMMITTEE

Application for Approval of Research Projects *

Nature of Proposed Research:-

(a) Staff Research Y/N

(b) Student Research Y/N Degree ........... Course Code .............

Project Title: - ....................................................................................

...................................................................................

Investigators: -

(a) Principal Investigator

Name .....................................................................................

School/Dept/Group ......................................................................

Any Professional Code of Ethics to be followed

(Name) ..................................................................................

(b) Other Researchers Name Position

.......................................... ............................

.......................................... .............................

........................................... .............................

Proposed Starting Date .......................................................

Proposed Date of Completion .......................................................

Proposed Source of Funding .......................................................

* Please write legibly or type if possible. A copy of this document can be printed from the WWW at http://www.vuw.ac.nz/administrative/hec

Briefly Outline:

(a) The Objectives of the Project

(b) Method of Data Collection

(d) Characteristics of the Participants

(e) Method of Recruitment

(f) Payments that are to be made/expenses to be reimbursed to participants

(g) Other assistance (e.g. meals, transport) that is to be given to participants

(h) Special hazards and/or inconvenience (including deception) that participants will encounter

(i) How informed consent is to be obtained (Include a copy of the consent form and information sheet that is to be used.) (See paragraphs 4.3.1(g), 5.2, 5.5 and 5.6.1 of the guidelines). If written consent is not to be obtained, please explain why

(j) State whether the consent is for the collection of data, attribution of opinions or information, release of data to others, or use for particular purposes

(k) Whether the research will be conducted on an anonymous basis. If not, state how issues of confidentiality of participants are to be ensured if this is intended. (See paragraph 4.3.1(e) of the guidelines) (e.g. who will listen to tapes, see questionnaires or have access to data)

(l) Procedure for the storage of, access to and disposal of data, both during and at the conclusion of the research. (See section 7 of the guidelines)

(m) Feedback Procedures (See section 8 of the guidelines)

(n) Reporting and Publication of Results

Signature of Investigators as listed on page 1 (including Supervisors)

................................................... ..................................................

Date: ...................................................

Please send this completed application form to the Secretary, Human Ethics Committee, Hunter Building or, in the case of applications from Schools or Departments with an approved ethics sub-committee, to the Convener of that sub-committee.

APPLICATIONS FOR HUMAN ETHICS APPROVAL

CHECKLIST

9 Have you read the Human Ethics Committee Guidelines?

9 Is ethical approval required for your project?

9 Have you established whether informed consent needs to be obtained for your project?

9 In the case of student projects, have you consulted your supervisor about any human ethics implications of your research?

9 Have you included an information sheet for participants which explains the nature and purpose of your research, the proposed use of the material collected, who will have access to it, whether the data will be kept confidential to you, how anonymity or confidentiality is to be guaranteed?

9 Have you included a written consent form?

9 If not, have you explained on the application form why you do not need to get written consent?

9 Are you asking participants to give you consent to

- collect data from them

- attribute information to them

- release that information to others

- use the data for particular purposes

9 Have you indicated clearly to participants on the information sheet or consent form how they will be able to get feedback on the research from you (e.g. they may tick a box on the consent form indicating that they would like to be sent a summary), and how the data will be stored or disposed of at the conclusion of the research?

9 Have you included a copy of any questionnaire you propose using?

9 Has your application been seen by the head of your school or department (or the person given responsibility to consider applications on behalf of the head (see Guidelines 5.3.2)).