Application for Ethical Review of Research Involving Humans

SUPPLEMENTARY FORM B

APPLICATION FOR ETHICAL REVIEW OF RESEARCH INVOLVING HUMANS

Research with Aboriginal and Torres Strait Islanders(ATSI)-
Supplementary Information

(To be submitted together with the standard ethics application)

Applicants are required to complete this form if the research specifically targets or is likely to include a significant number of participants who are Aboriginal or Torres Strait Islanders.
Applicants are requested to refer to the NHMRC National Statement Chapter 4.7 and NHMRC (2003) Values and
Ethics: Guidelines for Ethical Conduct in ATSI Health Research when completing this form.
1. Research project
Project Title
Chief Investigator - A
Co-investigators:
(including students)
2. Investigator experience
Provide details of investigators’ expertise or experience related to undertaking research with the ATSIpopulation(s) involved in the project.
Chief Investigator - A:
Co-investigators:
3. Student researchers
Will students be involved in any aspect of the research process that engages with ATSI members?
Yes No
If YES, what training or experience does the student(s) have relevant to the conduct of research with ATSI populations?
Provide details of training/experience:
If none, indicate what training will be provided and when:
4. Investigator roles
Describe the role(s) of each investigator(including any students) in the project.
Chief Investigator - A:
Co-investigator 1:
Name:
Co-investigator 2:
Name:
Co-investigator 3:
Name:
Co-investigator 4:
Name:
Student researchers:
5. Consultative process with ATSI peoples
a) Describe the process of consultation with ATSI members in the design and conduct of the research. Includedetailsof any
community groups or agencies involved in the consultative process.
b) Describe the process of engagement of ATSI members in the interpretation of research data.
c) What agreements have been negotiated with relevant ATSI members regarding ownership of the research and any rights of
access to resulting intellectual and/or cultural property?
d) Describe the process for determining an agreed arrangement between the investigators and the relevant ATSI community or
agency regarding publication and dissemination of research findings?
Attach supporting evidence from relevant ATSI communities or agencies with regard to the research agreement and decision making processes.
6. Informed consent
In some ATSI communities, consent is not only a matter of individual agreement, but involves other interested parties, such as formally constituted bodies, community collectives or elders.
a) Describe the process undertaken to ascertain the appropriate levels of consent required for the ATSI communityinvolved in
the research.
b) Indicate all interested parties from whom informed consent will be obtained and the procedures for obtainingconsent.
7. Benefits of the research
a) Describe how the research may contribute to the advancement of ATSI participants and/or communities.
(e.g., through the development of skills and knowledge or through broader social, economic or political strategies at local,
jurisdictional and/or national level)
b) Have the potential benefits of the research been discussed with and agreed to by relevant ATSI stakeholders?
Yes No
If NO, provide reasons:
8. Other relevant information?
9. Signature of Chief Investigator - A
Name / Date:
Signature

VU Human Research Ethics Application - ATSI Participants Supplementary Form 1