Research Ethics Board

Form PPM 1-12C

Application forEthics Approval forResearch InvolvingHumans

Be sure toanswerall questions.Enter“n/a” inthoseboxes thatare “notapplicable”—donot leave ablank.The proposedstart date oftheprojectwillcommencenosoonerthanthe date of approval by the Research Ethics Board.

Completedforms and appendices are to be senttotheChair of the NICResearchEthics Boardby e-mail.

A – CONTACT INFORMATION

A1 | Project Title

ProjectTitle:Click here to enter text.

ProposedStartDate:Click here to enter a date.ProposedCompletionDate: Click here to enter a date.

A2 | Principal Investigator Information

Name:Click here to enter text.

Email:Click here to enter text.

Role of the PI:Click here to enter text.

Department or Program:Click here to enter text.

Institutional Affiliation:Click here to enter text.

Category:☐ Faculty☐ Staff☐ Administrator☐ Student☐ Other

IfOther,providedetail: Click here to enter text.

Mailing Address: Click here to enter text.

Phone: Click here to enter text.

A3 | Co-Investigator Information

If more than one co-investigator, please append the information using “other” in the Appendix Checklist.

Name:Click here to enter text.

Email:Click here to enter text.

Role of the Co-Investigator:Click here to enter text.

Department or Program:Click here to enter text.

Institutional Affiliation:Click here to enter text.

Category:☐ Faculty☐ Staff☐ Administrator☐ Student☐ Other

IfOther,providedetail: Click here to enter text.

Mailing Address: Click here to enter text.

Phone: Click here to enter text.

B – PROJECT OVERVIEW

B1 | Description of the Research Project:

  1. Provideaclearstatement of the purpose and objectives of theproject.

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  1. State the hypothesis, the research question, or both.
  1. Provideabriefdescriptionofexactlywhatyouwillbeaskingyourparticipantstodo.

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  1. Provideabrief summary(not morethan250words)ofthemodeofinquiryfortheresearch.Notetheresearchdesign,research methods,or both,and asequentialdescription oftheprocedurestobefollowed.Providedetailsaboutthemethodsandtechniquesof datacollectionanddataanalysis,participantprotocols/instruments,locationoftheresearch andtimecommitmentfortheparticipants.

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  1. Providedetailsonhowandwheredatainvariousformatswillbestored,who willhaveaccesstothedata,whenitwillbedestroyed,andhowit willbedestroyed.

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  1. Appenda copyofeachresearchinstrumentandprotocoltobeused.

☐ Attached☐ NotAttachedAppendix: Click here to enter text.

B2 | Conflict of Interest

  1. Identifyactual, apparent,orpotential conflictsofinterest.Provideemploymentandfundinginformation,pastandpresent,ifitisrelevanttoanypossible conflictofinterest:

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  1. Describe how potential or actual conflict of interest will be mitigated.

C – RECRUITMENT AND CONSENT

C1 | Description of Sample/Participants/Populations

  1. Describetheproposednumberandtypesofparticipantstobeincluded; ifparticipantsaregrouped,specifythenumberandassignment criteriaforeach group:

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  1. Listparticipantinclusionorexclusion criteria;salientcharacteristicsofparticipants:

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  1. If your research project involves Indigenous individuals and/or communities (in Canada or othercountries), please read Chapter 9 – Research Involving First Nations, Inuit, and Metis peoples of Canada in Tri- Council Policy Statement (TCPS2, 2014) and providea brief explanation of how you have attended to the following concerns in the design,implementation and evaluation of your research project:
  2. Consultation and involvement of Indigenous individuals and/or communities:

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  1. Integration of cultural competence and cultural safety:

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  1. ☐ I have read Chapter 3 of the Tri-Council Policy Statement and my consent process meets the principles described therein. Describe any issues or concerns:

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  1. Is there any compensation or other inducement for participating in the research? (e.g. gifts, money, social advantage, bonus points)

☐ Yes☐ No

If yes, explainthenatureofthe compensation andwhyyouconsider itnecessary:

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C2 | Benefits and Risks

1.Identifyanypotentialorknown benefitsassociated withparticipationbyparticipants to the College, tosociety ortothe bodyofknowledge:

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2.“Minimal risk research is defined as research in which the probability and magnitude of possibleharms implied by participation in the research is no greater than those encountered by participants in those aspects of their everyday life that relate to the research.” p.22

Usingthe TCPSdefinitionof“minimalrisk” citedabove,do youbelieveyour researchqualifiesas“minimalrisk”research?

☐ Yes☐ No

Explain your answer byreferringtothelevelofriskstatedintheTCPSdefinition:

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3.Doesthestudyinvolveany of thefollowingrisks:

a)A participant may feel demeaned or embarrassed during their participation in the research.
☐ Very Unlikely☐ Possibly☐ Likely

b)A participant may experience fatigue or stress due to the research.
☐ Very Unlikely☐ Possibly☐ Likely

c)A participant may experience other emotional or psychological discomfort as a consequence of participation.
☐ Very Unlikely☐ Possibly☐ Likely

d)Aparticipant may experience social risk, possible stigmatization, loss of status, privacy or reputation.
☐ Very Unlikely☐ Possibly☐ Likely

e)A participant may experience physical risk?
☐ Very Unlikely☐ Possibly☐ Likely

f)A participant may experience an economic risk (e.g. job security, job loss)?
☐ Very Unlikely☐ Possibly☐ Likely

g)If you indicated in items (a) to (f) that any risks are possible or likely, please explain what the risks are, how these will be minimized, and describe how you will respond if a risk of harm occurs (e.g. risk management or mitigation):

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4.Doesthisresearchstudypose anyriskstotheresearchers,assistantsordatacollectors?

☐ Yes☐ Possibly☐ No

If yes or possibly, please explain what the risks are, how these will be minimized, and describe how you will respond if the risk of harm occurs (e.g. what is your plan):

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C3 | Informed Consent

  1. Who will be recruiting the participants?

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  1. From where will the research participants be recruited? (Specify cities, institutions, schools, business, etc.)
  1. Providesignedevidenceof supportfor accessto researchparticipants, sites,orboth, ifapplicable.

☐ Attached☐ Not Attached Appendix: Click here to enter text.

4.The TCPS2 suggests that Indigenous community agreement may be required when research involves Indigenous people, the cultural knowledge and /or resources of Indigenous people, or where individuals speak on behalf of Indigenous people. Please read Chapter 9 of TCPS2 and address any issues.

  1. Doesyourresearchspecificallystudyandinvolve:

Individualsfrom anIndigenouscommunity?

☐ Yes☐ No

If yes, howhaveyouattendedtothepotentialrelationshipbetweenthe Indigenousindividual’sparticipation inthestudyandthecollectivewelfareofthebroaderIndigenouscommunity?

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  1. Does your research specifically study or involve:

An Indigenous community member or Indigenous community as a central focus of the research?

☐ Yes☐ No

If Yes, have you sought approval from the Indigenous community (or communities) involved in the study?

☐ Yes☐ No

If No, briefly justify your decision not to seek Indigenous community approval.

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  1. Isaresearchagreementconfirmingmutualexpectationsandcommitmentsbetweenresearchersand indigenous communitiesinplace?

☐ Yes☐ No

If No, briefly justify your decision not to seek a research agreement.

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5.Review and referto North IslandCollege’spolicy#1-12 Research Involving Humansfrom other cultures, religions or ethnic groups toanswerthefollowingsection.

  1. Does your research specifically study and involve:

Individuals from a different cultural, religious or ethnic group?

☐ Yes☐ No

If yes, how have you attended to the potential relationship between the individual’s participation in the study and the collective welfare of the broader cultural/religious/ethnic group?

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  1. Does your research specifically study and involve:

A particular cultural or ethnic group and/or community as a central focus of the research?

☐ Yes☐ No

If Yes, have you sought approval from the cultural or ethnic group and/or community involved in the study?

☐ Yes☐ No

If No, briefly justify your decision not to seek approval from the cultural or ethnic group and/or community:

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  1. Isaresearchagreementconfirmingmutualexpectationsandcommitmentsbetweenresearchersand cultural, religiousor ethnicgroupinplace?

☐ Yes☐ No

If No, briefly justify your decision not to seek a research agreement:

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  1. Are youoranyofyour co-investigators in apositionofauthorityorpoweroverparticipants?(e.g.teachers-students,therapists-clients,supervisors-employees,culture/ethnicgroup/firstnations,andpossiblyresearcher-relativeorresearcher-closefriend)

☐ Yes☐ Possibly☐ No

If yesorpossibly,describe:

  1. Thenatureofthe relationship.

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  1. Justifywhyitisnecessaryto conduct researchwithparticipantsoverwhom you,theresearcher,or your co-investigator havepower.

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  1. Whatsafeguards(steps)willbetakentominimizea potential for conflict through inducement,coercionorpotentialfor harm?

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  1. Howwill thedual-rolerelationshipandsafeguardsbeexplainedtothepotentialparticipant?

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  1. InformedConsentProcess
  2. Describethesteps or proceduresto be followed forobtaininginformed consentof the participants foreachdistinctcomponent of yourstudy(e.g.,forinterviews,questionnaires,focusgroups,participantobservation,observation):
  1. Willyourresearchoccurovermultipleoccasionsorfor anextendedperiodoftime?

☐ Yes☐ No

If yes, describehowyouwill obtainongoingconsent:

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  1. Describewhat willbetoldtoparticipantsabouttheirrighttowithdrawat anytime?

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  1. If compensationor other inducements areinvolved, explainwhatparticipants will be toldaboutcompensation etc. if they withdraw.

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  1. Whathappenstotheperson’sdataifthe participantwithdraws?

☐Itwillnotbeusedintheanalysis.

☐Itwill beusedin theanalysisif theparticipantagreesto this.Describehowthisagreementwillbeobtained:

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  1. In the caseofindigenouscommunities and their members, how will you ensureongoing“processconsent”?

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  1. Willparticipants be informed of everything that will be required of them prior to thestart of the research interview, discussion, focus group or survey?

☐ Yes☐ No

If no,please explainwhythisisnecessary:

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8.Notethatdeceptionis not permittedwhenthere isrisk orharm tothesubject orwhenitisnotpossibletoadvisesubjectssubsequentlyastothereasonswhythedeceptionwasnecessary.

a.Will deception be used at any point throughout the study?

☐ Yes☐ No

If Yes, please explain how it is being used and why:

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9.Confidentialitymeansthattheprotectionoftheperson’sidentity(anonymity)andtheprotection,access,control andsecurityofhisorherdataandpersonalinformation duringtherecruitment,datacollection,reportingoffindings,disseminationoffindings,disseminationofdata(ifrelevant)andafterthestudyiscompleted(e.g.storage).

a.Will you be able to ensure anonymity of the participants?

☐ Yes☐ No

If No, explain why:

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  1. Describe the procedures to be used to ensure anonymity of participants and forpreserving the confidentiality of their data:

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  1. Are there limitations to ensuring anonymity where group activities are employed? (e.g. focus groups)

☐ Yes☐ No

If No, explain why:

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If Yes, please explain the limitations due to group activities:

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  1. Are there limitations due to context where the nature or size of the sample from which participants aredrawn makes it possible to identify individual participants? (e.g. school principals in a small town)

☐ Yes☐ No

If yes, please explain limitations due to the context.

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  1. Are there limitations due to selection where the procedures for recruiting or selecting participants may compromise the confidentiality of participants? (e.g. participants are identified or referred to the study by a person outside the research team)

☐ Yes☐ No

If yes, please explain limitations due to the context.

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  1. Are there limitations due to legal requirements for reporting?

☐ Yes☐ No

If yes, please explain limitations due to the context.

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  1. Are there any other limitations not noted above. If so, please explain:

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  1. Appenda copyofeachinformationletter,script,or consentformthatwillbeusedto ensurethatparticipantsaregivinginformedconsent fortheirparticipation.

☐ Attached☐ NotAttachedAppendix: Click here to enter text.

C4 | Use and Disposal of Data

1.UseofData

  1. Whatuse(s)will bemade ofthedata?

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  1. Willyourresearchdatabe analyzed,noworinthe future,byyourselfor others forpurposesotherthanthisresearchproject?

☐ Yes☐ Possibly☐ No

Ifyesorpossibly, bywhom andhowwill youobtainconsentfromtheparticipantsforfuturedataanalysisbyotherresearchers?

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  1. Doyouanticipatethatthisresearchwill beusedfor acommercialpurpose?

☐ Yes☐ No

Ifyes,explainthecommercialpurpose:

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2.Describeyourplansforretainingandprotectingdataorfordestroyingdataaftertheresearchiscompleted.Forall data(e.g.paperrecords,audioorvisual recordings,electronicrecordings),indicatethe:

  1. Meansofstorage:(e.g.alockedfilingcabinet,passwordprotected computerfiles)

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  1. Location ofstorage:

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  1. Timedurationofstorage:

D-DISSEMINATION

1.Howdo youanticipatedisseminatingyour researchresults?(checkallthatapply)

☐Directlytoparticipants

☐Presentationsatscholarlymeetings

☐Internet

☐Thesis/dissertation/classpresentation

☐Publishedarticle,chapterorbook

☐Media(e.g.newspaper,radio,TV)

☐Other,explain:

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2.Will the participants inyour studybeadvisedofthe meansfor disseminating your research results?

☐Yes☐No

If yes,howweretheyadvised?Click here to enter text.

If no,explain:Click here to enter text.

E–AGREEMENTANDSIGNATURES

AsthePrincipalInvestigator,Iaffirmthat:

  • Ihavereadthisapplicationandit iscompleteandaccurate.
  • Theresearchwillbeconducted in accordance with NorthIsland college regulations,policiesandproceduresgoverningtheethical conductofresearchinvolvinghumanparticipants.
  • Theconductoftheresearchwill not commenceuntilethicsapprovalhasbeengranted.
  • Theresearcher(s)willadvise the Chair of North Island College Research Ethics Board if furtherreviewiftheresearchprotocolismodified.

PrincipalInvestigatorSignatureDate

Co-ApplicantSignatureDate

FOR OFFICE USE ONLY:

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Revised: October 20, 2015Page 1

Research Ethics Board

Form PPM 1-12C

AppendixChecklist

Use the checklist to ensure that all of your appendices are clearly labeled and attached.

Please ensure that the reading level of all materials produced or used are appropriate for the targetaudience.

ReferenceList / SeeAppendix
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Research Instruments / SeeAppendix
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EvidenceofSupport / SeeAppendix
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RecruitmentAids(notices in coursematerials,posters,e-mailannouncements,newspaperadvertisements,radio announcements,lettersofinvitation,etc., / SeeAppendix
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Informed Consentdocuments(InformationLettersorScripts,ConsentForms(maybecombinedwith “RecruitmentAids”) / SeeAppendix
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Other(pleaselistand describe):
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Revised: October 20, 2015Appendix 1