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SECTION A – RESEARCH PROJECT OVERVIEW Title of Research Project: Principal Investigator: Title: Name: Department: Institution/Agency/Org: Mailing address (if not Algoma U) Phone: Fax: Email: Alternate Contact (e.g., Research Coordinator): Title: Name: Phone: Fax: Email: Co-Investigators: Are co-investigators involved? No Yes *YES: please fill out SECTION B (2). Research start and end dates (Year/Month/Day): *Research Start Date is AFTER REB clearance. Estimated start date for research project: Estimated start date for data collection: Estimated completion date for completion of research: Estimated date for providing participants with feedback (if applicable): EXPEDITED or FULL REB REVIEW : Research which poses only minimal risk may qualify for Expedited Review. Please consult Algoma University REB guide for Expedited review criteria. 1 Research Ethics Review Application: RESEARCH INVOLVING HUMAN PARTICIPANTS Office of the research Review Ethics Board OFFICE USE ONLY: Form revised Fall 2017 Accepted as is Clearance Pending Revision Clarification Required Full Review Resubmission Withhold Clearance Protocol Reference Numbers: REB#: _________________

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Page 1: Checklist - Algoma University · Web viewAn electronic version (PDF or Word) of this application & all appendix has also been submitted to: ... Interview Oral/Life history Collecting

SECTION A – RESEARCH PROJECT OVERVIEW

Title of Research Project:

     

Principal Investigator:

Title:       Name:      

Department:       Institution/Agency/Org:

Mailing address (if not Algoma U)      

Phone:       Fax:       Email:      

Alternate Contact (e.g., Research Coordinator):

Title:       Name:      

Phone:       Fax:       Email:      

Co-Investigators:Are co-investigators involved? No Yes *YES: please fill out SECTION B (2).

Research start and end dates (Year/Month/Day): *Research Start Date is AFTER REB clearance. Estimated start date for research project:      Estimated start date for data collection:      Estimated completion date for completion of research:      Estimated date for providing participants with feedback (if applicable):      

EXPEDITED or FULL REB REVIEW: Research which poses only minimal risk may qualify for Expedited Review. Please consult Algoma University REB guide for Expedited review criteria.

This Research qualifies for EXPEDITED review: OR This Research qualifies for FULL review*: *ALL research requiring the use of a form of deception automatically requires Full Review.

Please provide a brief (max. 100 words) rationale as to why your research qualifies for expedited or full review.

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Research Ethics Review Application: RESEARCH INVOLVING HUMAN PARTICIPANTS

Algoma University Office of the research Review Ethics Board

OFFICE USE ONLY: Form revised Fall 2017

Accepted as is Clearance Pending Revision Clarification Required

Full Review Resubmission Withhold Clearance

Protocol Reference Numbers:

REB#: _________________

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An electronic version (PDF or Word) of this application & all appendix has also been submitted to:

     

SECTION B: GENERAL RESEARCH PROJECT INFORMATION

1. FACULTY, FACULTY SUPERVISOR -or- FACULTY SPONSOR: (if applicable)

Title:       Name:      

Department/Agency:      

Mailing address:      

Phone:       Fax:       Email:      

2. CO-INVESTIGATORS (if applicable)

Title:       Name:      

Department/Agency:      

Mailing address:      

Phone:       Fax:       Email:      

Title:       Name:      

Department/Agency:      

Mailing address:      

Phone:       Fax:       Email:      

Title:       Name:      

Department/Agency:      

Mailing address:      

Phone:       Fax:       Email:      

*Please append additional pages if necessary.

3. LOCATIONS WHERE RESEARCH WILL BE CONDUCTED:(Please indicate all that apply)

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NOTE: If location of research dictates specific administrative clearance/consent, include all clearance/consent documents including drafts. If the research requires yet another form of clearance, the researcher(s) is responsible for acquiring this.

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Algoma University Band Council On Reserve, Territory Hospital - (specify site[s])       School board/community agency - (specify site[s])       Community within the Algoma District - (specify site[s])       International - (specify site[s])       Other - (specify site[s])      

4. OTHER RESEARCH ETHICS BOARD CLEARANCE(S): *Seek AU REB clearance BEFORE seeking clearance from another Institution’s REB. a) Has any another REB cleared this research? No Yes *Yes: provide a copy of the clearance letter along with this application.

If No, will any other REB be asked for research clearance? No Yes

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If Yes, from which institution?

     

5. FUNDING OF THE RESEARCH

(a) Research is Unfunded: Yes No * NO: Indicate status of funding .

Applied for Funding Agency:      Title of research project associated with funding (If different from name submitted to REB.)      

Submission dates:      Funded Agency:      

Title of research project associated with funding (If different from name submitted to REB.)      

Funding date:      *If funding protocol covers more than one grant, please include all fund or /grant numbers.

(b) If waiting for funding, do you wish REB clearance to be postdated to funds release-date? No Yes

(c) For FUNDED research, are there additional protocols that cover the research? No Yes If Yes, please list these protocols by title and RIS # (if known):

     

6. CONTRACTSa) Is there an contract or agreement associated with the research? No Yes*YES: include a copy of the agreement with this application.

b) Will the results of research be used to financially benefit the researcher(s)? No Yes

If Yes, please explain:

     

7. REB REVIEW OF ONGOING RESEARCH

a) Are there any specific characteristics of this research that require additional REB review as research proceeds? No Yes

If Yes, please explain:

     

b) Where relevant, please propose a continuing review process that you deem to be appropriate?

     

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NOTE: REB clearance is for ONE year. Research continuing beyond one year, requires submission of an Annual Renewal Application Form.

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8. SCHOLARLY REVIEW: (Check ONE of the following) Research will NOT undergo scholarly review apart from the AU REB. Research underwent scholarly review prior to AU REB submission (e.g., grant application, faculty supervisor, etc.).

Please specify which type):       Research will undergo scholarly review prior to receiving funding. Please identify which REB:       Other type of review. Please specify:      

9. CONFLICTS OF INTEREST, DUAL ROLES, RELATIONSHIPS

(a) Will the researcher(s), research team members, and/or their partners or immediate family members receive any personal benefits (e.g. financial benefit, intellectual property rights, rights of employment, consultancies, etc.) because or

in connection, with this study? No Yes

If Yes, please describe the benefits. (*Does not apply to conference and/or travel expense coverage or other benefits standard in conducting research):

     

(b) Where relevant, please address pre-existing relationship between the researcher(s) and those individuals/groups being researched (e.g. instructor-student; manager-employee; minister-congregant, Band membership).

     

c) Describe any restrictions regarding access to or the disclosure of information (during or at end of the study) placed on the investigator(s). E.g., controls placed by sponsors, funders, Band Councils, advisory or steering committees.

     

SECTION C – SUMMARY OF THE PROPOSED RESEARCH

*Please include a list of appendices for all additional materials submitted.

10A. RATIONALE

Describe succinctly the purpose and rationale for the proposed research, and the hypotheses or research question(s) to be examined. Include all information that an educated layperson needs to understand the purpose of the proposed research.

     

10B. KEYWORDS:

Please provide 6 to 8 ‘Key Words’ to identify the research project.

     

11. RESEARCH METHODS

Are you engaging in any of the following: * Yes: Audio/Video Consent form will be required. Audio Recording: Photographs: Video Recording:

Yes: describe the rationale for doing so.

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Please indicate all the research methods that apply:

Action Research Ethnography Observation Survey Documentary/Filmmaking Focus Group Experimental lab study Interview Oral/Life history Collecting of Human Tissues Experimental behavioral study Cultural Products Online Research (* YES: complete REB online research checklist) Other      

Please provide a step-by-step outline for EACH of the research methods to be used. Include settings, types of information involved, materials produced and how data will be analyzed. Include specifics re: procedures participants will undertake. INCLUDE all study instruments as Appendices.

Method #1:

      Method #2 (if applicable):

     

Method #3 (if applicable):

     

12. DECEPTION (Generally, applications involving use of deception will require FULL REB review. *Researchers employing deception are required to complete SECTION C (22) (c) and C (22) (d)

Will deception be used in this study? No YesIf Yes, please describe and justify the need for deception:

     

13. PARTICIPANTS/INFORMANTS

Describe anticipated participants/informants to be recruited along with any the types of personal information to be collected, age range, special characteristics, etc. Describe inclusion and/or exclusion criteria. Where the research collects personal information, please describe from whom the information is obtained and what it is included (include permission letters).

     

14. RECRUITMENT

Please describe how and from where, research participants will be recruited. Indicate if there is a different recruitment method for each research method used. ATTACH copies of recruitment tools such as posters, advertisements, web postings, flyers, etc.

     

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Where participant observation is to be used, explain how the researcher will gain entry to the area to be observed and how observation(s) will take place, e.g., living in a community, visiting on a bi-weekly basis, attending organized functions, etc.) If permission was required for observation(s) attach letter(s) of permission from organization, community, Band Council, etc.

     

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15. EXPERIENCE

Please provide a brief description of ALL members of researcher’s/research team’s experience (rather than credentials) with each type of research. If research members require training or acquiring skills prior to beginning research, how will this be acquired?

     

16. COMPENSATION/INCENTIVE

(a) Will participants receive compensation for participation? (Please check all that apply)NO, NONE Financial In-kind Draw Prize Other       

(b) If compensation is provided, please provide the source of funding, goods, services used for the compensation/incentive:     

(c) If compensation is provided, please provide details and justification for the compensation offered:     

(d) If participants choose to withdraw from the research procedure, how will compensation be dealt with? I.e., do they receive it regardless?

     

SECTION D – DESCRIPTION OF THE RISKS AND BENEFITS OF PROPOSED RESEARCH

17. POSSIBLE RISKS

Please indicate potential risks that the participant(s) either as individuals or as part of an identifiable group or community, might experience because of participating in this research project: (*IF using more than 2 methods, please append additional pages for the risk matrix for those methods).

Method #1:      (a) Physical risks (including any bodily contact, distress or administration of any substance)?

Low Medium High (b) Psychological and/or emotional risks (feeling uncomfortable, embarrassed, anxious or upset)?

Low Medium High (c) Social risks (including possible loss of status, privacy and/or reputation)?

Low Medium High (d) Risks posed by being in a dual/multiple relationship with study participants?

Low Medium High (e) Data security risks (i.e., risk to participant from data exposure)?

Low Medium High (f) Risks posed by use of deception involved in the study? (See DEBRIEFING section below)

Low Medium High

Method #2 (if applicable):      (a) Physical risks (including any bodily contact, distress or administration of any substance)?

Low Medium High (b) Psychological and/or emotional risks (feeling uncomfortable, embarrassed, anxious or upset)?

Low Medium High (c) Social risks (including possible loss of status, privacy and/or reputation)?

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Low Medium High (d) Risk posted by being in a dual/multiple relationship with study participants?

Low Medium High (e) Data security risks (i.e., risk to participant from data exposure)?

Low Medium High (f) Risks posed by use of deception involved in the study? (See DEBRIEFING section below)

Low Medium High

18. RISK MATRIX *Please consult the Instructions for Ethics Review Protocol Submission Form.

(a) Please complete the following:

Method #1:      Research RiskLow Medium High

Group VulnerabilityLow 1 1 2Medium 1 2 3High 2 3 3

Review Type:

Overall Risk level = 1: Expedited ReviewOverall Risk level = 2: Expedited Review or Full Review at the discretion of the REB Chair Overall Risk level = 3: Full Review

* The level of Review Type and level of Continuing Review will be determined by the Algoma University REB.

(b) For EACH method, briefly explain/justify your assessment of the level of risk and group vulnerability reported above.

     

(c) Based on the above, please explain and describe how the potential risks are to be managed and/or minimized.

     

19. POSSIBLE BENEFITS TO PARTICIPANTS

Discuss any potential benefits to the participants resulting from involvement in the research. These may include education about research methods, gaining useful knowledge, etc. Comment on the (potential) benefits to the scientific/scholarly community or society that justify the involvement of participants in this study.

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NOTE: The risk presented on matrix will determine the REB requiring an expedited or full review AND level of continuing review for the research project.

Method #2 (if applicable):

     

Research RiskLow Medium High

Group VulnerabilityLow 1 1 2Medium 1 2 3High 2 3 3

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SECTION E – THE INFORMED CONSENT PROCESS

20. DESCRIPTION OF THE CONSENT PROCESS

Participants Capacity to Provide Informed Consent: * Indicate and check the box(s) which best apply to your participants:

Competent Non-Competent Competent Adult Vulnerable Population (See TCPS2 criteria)

Non-Competent Adult Consent from authorized party will be obtained Assent from the participant will be obtained

Competent Youth Consent of both youth and parent/guardian required Consent of youth required and parents are informed Consent of youth required and parent/guardian are not

informed

Non-Competent Youth Consent from parent/guardian Assent from the youth will be obtained

Competent Children Consent of parent and child Other:      

Non-Competent Children Consent from parent/guardian Assent from the child will be obtained

(a) Describe the process whereby investigator(s) obtain informed consent. If written consent is not received (e.g., due to discipline, cultural appropriateness, poses a risk, etc.) please explain reason for this. If the research involves extraction or collection of personal information from a participant, please describe how consent from the individuals or authorized custodian is obtained and documented.

     

* Please attach a copy of the Information Letter, (where appropriate) the Consent Form, Audio/Video Recording Consent Form, the script for any telephone or email communication, letters of administrative consent or authorization and/or any other material(s) used in the informed consent process.

b) Ongoing Consent is required if the research occur over multiple occasions or an extended period. Does the research occur over multiple occasions and/or an extended period? Yes No

Please describe the process of how you intend to obtain ongoing consent?

     

(c) If the Title of the Research Project communicated to participants (e.g. on Consent Form/ Letter of Information) differs from the Title provided to the REB, provide this alternate title:

     

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NOTE: See TCP2 Guidelines for information about elements required in information letters and consent form. All consent forms must outline procedure for participant WITHDRAWAL from project.

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(d) Please provide the rationale for difference in Title:

     

21. CONSENT BY AN AUTHORIZED 3rd PARTY

(a) If the participants are children, or are not competent to consent, describe the authorized alternate source of consent.

     * Attach a copy of any permission/information letters provided to the authorized person(s) providing alternate consent and the assent process for the actual participants.

(b) If the research takes place within a recognized community or an organization requiring that formal consent be sought prior to the involvement of individual participants, describe the process for acquiring this consent and attach any relevant documentation. If consent was not sought, provide a justification for this; describe any alternative forms of consultation that may take place.

     

* Attach any relevant documentation.

22. POST-STUDY INFORMATION / FEEDBACK / DEBRIEFING

(a) Briefly describe the process whereby post-study information is provided to participants AND the rationale for providing this information (e.g. resource list, links, information about the study, etc.) *Not applicable in studies utilizing deception.

     

(b) Upon study completion how will participants be informed of study results?

     

(c) **(Use of Deception: to be answered only by researchers who have completed SECTION C (12)). If deception will be used in the research study, please explain what information/feedback will be provided to participants after their participation in the project.

     * Please attach a copy of the written debriefing form (if applicable).

(d) ** Use of Deception: to be answered only by researchers who have completed SECTION C (12)). Will participants and/or communities be given the option of withdrawing their data or contribution following the debriefing, i.e., the use of deception)? How will the participants and/or communities be informed, assured, that deception has terminated?

Please describe.

     

23. PARTICIPANT WITHDRAWAL

(a) Where applicable, please describe how participants will be informed of their right to withdraw from the project. Outline the procedures which will be followed to allow them to exercise this right.

     

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(b) Indicate how the data or contribution of the participant is handled should they withdraw. Indicate any consequences of their decision to withdraw.

     

(c) If beyond a certain point, participants do not have the right to withdraw from the project, please indicate when this is.

     

(d) Are there any other limitations on a participant’s ability to withdraw their data or contribution?

     

SECTION F – SAFEGUARDS FOR PROTECTING PARTICIPANTS AND DATA

24A. CONFIDENTIALITY And ANONYMITY

(a) Will the participant’s data or contribution be treated as confidential? No Yes

(b) Will the participant identity etc. be anonymous to the researcher, research staff, etc.? No Yes

(c) Describe the procedures used to ensure the confidentiality OR anonymity participants or informants (where applicable) –AND/OR the confidentiality of data or contribution during the research process and dissemination of results.

     

(d) If participant confidentiality or anonymity is not appropriate to this research project, please explain.

     

(f) Describe any limitations to protecting the confidentiality of participants whether due to the law, the methods used, the nature of the sample population, or other reasons (e.g., duty to report).

     

(e) Identify all parties who will have access to the data or contributions of participants.

     

24B RESEARCH DOCUMENTS AND DATA STORAGE

1) Explain how and where written records, video/audio recordings, artifacts, and questionnaires are secured and stored? How long will records, data, etc. be retained? How, when and where will they be finally stored (e.g., archived) or disposed? Using the standard data security procedures for your discipline and provide a justification if you intend to

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! NOTE! Confidentiality is the ethical and/or legal responsibility to safeguard information entrusted to researchers, Research staff, etc. E.g., limiting access to information, identifiers, etc. Anonymity is the state whereby participants’ identification, individuality, distinction, or recognisability is not disclosed to the research team or other parties.Please review TPC2 guidelines for information on distinguishing anonymity and confidentiality.

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store your data for a longer period. If the data may have archival value, discuss this and whether participants were informed of this possibility during the consent process.

     

SECTION G – CONTINUING REVIEW OF ONGOING RESEARCH

Level of Continuing Review Each of the three risk levels (risk matrix) is associated with a program of continuing review. Generally, the three levels of continuing review can be summarized as follows: Level 1: All research protocols extending beyond one year require an Annual Renewal Report to the REB commenting on:

Any changes to the protocol, forms, or personnel (e.g., status as students or employees) The number of participants currently in the study, or who have completed the study, or who withdrew (including their

reasons for withdrawing) Any ethical concerns that have arisen Researchers should submit a Final Report when data analysis has been completed to answer the original research

question(s)

Level 2: In addition to being subject to Level 1 review, mid- and high-risk protocols have a small chance of receiving a routine site visit, including review of:

The REB’s file documenting the clearance process Researcher’s consent files documenting participant consent and eligibility

Level 3: in addition to being subject to Level 1 review, and having a small chance of being subject to Level 2 review, high-risk protocols have a small chance of receiving a routine site visit, including review of:

Researcher’s data files documenting adherence to or deviation from protocol, reporting of adverse/unanticipated events, and data quality; this may include audio or video recordings, electronic or paper records, field notes, etc.

(Under unusual circumstances), continuing review may also include direct contact with the research process (i.e., observing the consent or study procedures) if the researcher has received permission from the participant to do so, and the REB determines that the risks to participants do not outweigh the potential benefits. Under similar circumstances, continuing review may also include contacting participants during or after participation (e.g., by phone, or by appending relevant questions to study protocols); relevant questions may include how they were recruited, who they interacted with and in what capacity, whether they were given an opportunity to ask questions, whether they felt pressure to participate or continue, whether they are satisfied with their experience as a participant, and whether they have any other questions or comments. Such procedures, however, are not expected to be the norm.

SECTION H - SIGNATURES

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NOTE: PRIVACY REGULATIONS AND APPLICABLE LAWS: For research involving extraction or collection of personal information, provincial, national and/or international laws may apply. The signature of Principal Investigator—required in this section—confirms that they understand and will comply with all relevant laws governing the collection and use of personal information in research.

! NOTE! Investigators: All digital copies of this application must be accompanied by hard copies, signed by All investigators. Digital applications must be sent via your Algoma University email account to the REB.

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All researchers must sign below for this application to be processed and reviewed.

As the Principal Investigator on this project, my signature confirms that I will ensure that all procedures performed under the project will be conducted in accordance with all relevant University, provincial, national and international policies and regulations that govern research involving human participants (see: AU REB Web site or Tri-Council Web site) for relevant documentation. Any deviation from the research project as originally cleared will be submitted to the REB for clearance prior to its implementation.

I certify that the information provided in this application is complete and correct, and approve the academic, scientific merit of the research project and this REB application.

I agree to comply with the Tri-Council Policy Statement and all Algoma University policies and procedures, governing the protection of human participants in research, including, but not limited to, ensuring that:

• The project is performed by qualified and appropriately trained personnel in accordance with REB protocol;• No changes to the REB cleared protocol or consent form/statement will be implemented without notification to the

REB of the proposed changes and receipt of the subsequent REB clearance;• Significant adverse effects are promptly reported to the REB within 5 working days of occurrence; and• At a minimum, a progress report is submitted annually or in accordance with the terms of certification.

Signature of Principal Investigator:       Date:      

Signature of Co-Investigator (s):       Date:      

Signature of Co-Investigator (s):       Date:      

Signature of Co-Investigator (s):       Date:      

Signature of Co-Investigator (s):       Date:      

Signature of Co-Investigator (s):       Date:      

Signature of Co-Investigator (s):       Date:      

Please provide one signed hard copy and one digital (in pdf form) to [email protected].

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! NOTE! Research continuing beyond one year, requires the submission of an Annual Renewal Application.

Upon research completion, a Research Project Completion Report must be submitted. Failure to do so or delays in doing so may cause delays in futures REB Reviews or funding.

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(Appropriate letterhead should be inserted)

[Sample Consent Form – Revise to suit study]** Element of consent form must mirror the relevant sections in the attached REB application.

CONSENT TO PARTICIPATE IN RESEARCH

Title of Research Project:

     

[If the study involves using different consent forms for different populations, identify the population group as the subtitle of the study.]

You are asked to participate in a research study conducted by:

     

[insert names and identify all investigators - faculty, student and other],

from the:

     

[insert department affiliation] at Algoma University.

     

[Identify sponsoring agency(ies)/organization(s).]

If you have any questions or concerns about the research, please feel to contact:

     

[identify contact person: Faculty Investigator(s)/Faculty Supervisor(s). Include daytime phone numbers for all listed individuals. For greater than minimal risk, include night/emergency phone numbers.]

PURPOSE OF THE RESEARCH     

[State what the study is designed to assess or establish.]

PROCEDURESIf you agree to participate in this study, you will be asked to:

     

[Describe the procedure step-by-step, using simple clear language. Medical and scientific terms should be defined and explained. Identify any procedures which are experimental.]

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[Specify if participant’s is assigned to study groups, length of time for participation in each procedure, the total length of time for participation, frequency of procedures, location of the procedures to be done, etc. Provide details about any plan to contact participants for follow-up sessions or subsequent related study.]

POTENTIAL RISKS AND DISCOMFORTS

     

[Describe any reasonably foreseeable risks, discomforts, inconveniences (including for example, physical, psychological, emotional, financial and social), and how these will be managed.]

[If there are significant physical or psychological risks to participants that might cause the researcher to terminate the study, please describe them.]

POTENTIAL BENEFITS TO PARTICIPANTS AND/OR TO SOCIETY

     

[Describe benefits to participants expected from the research. If the participant will not benefit from participation, clearly state this fact.]

     

[State the potential benefits, if any, to science or society expected from the research.]

COMPENSATION FOR PARTICIPATION

     

[State whether the participant will receive compensation of any kind. If not, state this. If participant will receive payment, describe remuneration amount and process for receipt.]]

CONFIDENTIALITY AND/OR ANONYMITY

Any information that is obtained about this study and that can be identified with you will remain confidential and will be disclosed only with your permission.

     

[Describe procedures to ensure confidentiality and/or anonymity of data or contributions and participants. Provide information on how data or contributions will be secured and how long they will be retained. If information will be released to any other party for any reason, state the person/agency to whom the information will be released, the nature of the information, and the purpose of the disclosure.]

     

[If activities are to be audio- or videotaped, describe the participant’s right to review and/or /edit the tapes, who will have access. Describe how other than research e.g., for education purposes (if consented to) they will be used and when they will be erased.

PARTICIPATION AND WITHDRAWAL

     

[Indicate any conditions and/or limitations on participant’s right to withdraw and/or how their data will be handled.] In addition, the researcher may withdraw you and/or your data or contribution from this research if circumstances warrant doing so. [If appropriate, describe the anticipated circumstances under which the participant’s involvement may be terminated by the investigator]. If participant will receive payment, describe remuneration amount and/or how withdrawal impacts this.]

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FEEDBACK OF THE STUDY RESULTS TO THE PARTICIPANTS

     

[Include a statement of whether a summary of the research findings will be available to participants and how/where/when they will be made available to participants.]

Date when research results are available:      

SUBSEQUENT USE OF DATA

These data may be used in subsequent studies, in publications and in presentations.

RIGHTS OF RESEARCH PARTICIPANTS

If you have questions regarding your rights as a research participant, contact: Research Ethics Board, [email protected].

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SIGNATURE OF RESEARCH PARTICIPANT/LEGAL REPRESENTATIVE

I understand the information provided for the study:

     

[insert title of study here] as described herein. My questions have been answered to my satisfaction, and I agree to participate in this study. I have been given a copy of this form.

SIGNATURE OF PARTICIPANT: ________________________________________________Name of Participant

__________________________________________ ______________________________________Signature Participant DATE

SIGNATURE OF INVESTIGATOR: I, acknowledge the above represents the terms under which I will conduct research.

_____________________________________ _______________________________________________Name of Investigator Signature of Investigator

_________________________________________DATE

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ChecklistWhere APPLICABLE please attach the following items, to your completed application. Check Circle

N/A (Q#3) Letters of Permission Allowing YOUR Research to Take Place on Site

N/A (Q#4) Decisions REQUIRED from Other REB Boards

N/A (Q#6) Funding Agreement Contract(s)

N/A (Q#11) Questionnaires and/or Test Instruments

N/A (Q#13) Letters of Permission for Obtaining Personal Information

N/A (Q#14) Recruitment Materials such as Posters, Letters, Advertisements, etc.

N/A (Q# 20) Participant Consent Form

N/A (Q#20) Letter of Information explaining the research project

N/A (Q#20) Audio or Visual Recording Consent Form

N/A (Q# 21) Parental/Guardian Information and Consent Form

N/A (Q# 22) Participant Debriefing Letter (Required IF deception is to be used.)

Signature for all investigators

Certificates of Completion for TCP2 Core online tutorial for all investigators.

N/A Checklist for On-line research.

! NOTE! If submitting an REB application to another institution, a final version of that application is to be submitted FIRST to the AU REB. AFTER review, it may then be sent to the other institution.

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