CREO “Request for Ethical Review” Application

CREO’s ethics review process can be found at: communityresearchethics.com/creo-services/

When completed, please submit this form by e-mail to

*Date:

*Name of Organization/Institution:

*Contact person:

*Telephone:

*Email:

*Address:

Fax:

*Principal researcher(s):

*Names and role(s) of co-researcher(s):

1.

2.

3.

4.

5.

6.

7.

*Title of Research Project:

*Proposed Start Date:

*Proposed End Date:

Summary of Purpose and Objectives of the research project

Please provide a simple-language summary of the purpose and objectives of the project. Identify any research partnerships and funding relationships. The details of this summary will also be explored in the Project Details section.

Summary of the Research Methodology and Procedures

Give a brief (approximately 500 words, please)and simple-language explanation of the method(s) and procedure(s) to be used in the project. Attach any proposed questionnaires, interview schedules, informed consent forms, etc. when submitting this application.

Project Details

1)Who is the research population? How many participants are you seeking? Will there be participants who are under the age of 16, captive participants, or vulnerable participants?

2)How was the community or population being studied involved in developing this project?

3)Who generated the research questions?

4)Where will the project be conducted?

5)What are the criteria for selection of research participants?

6)How will prospective participants be recruited?

7)How many participants are you seeking for each research method being used?

8)What is your process for acquiring free and informed consent from the participants, or from other people in cases where participants are unable to provide their own free and informed consent? Attach a copy of your informed consent form or participant information letter. If there is no informed consent process, please explain why this is not necessary for the project.

9)What potential risks exist for the research participants or to the community to which they belong? How will these be resolved?

10)What potential benefits exist for the research participants?

11) What potential benefits exist for the community?

12) Will any deception or concealment be employed? If so, please indicate the nature of this and why it is necessary for the research (attach additional documentation if necessary).

13)Is compensation (money/rewards) to be offered to research participants? Please provide details.

14)How much time will participants be asked to give to the project?

15)How will the data be collected? Who will be collecting the data from the participants? Who will have access to the research data?

16)How will privacy of the participants and the research data be protectedwith each of the data collection methods?

17)How will confidentiality of the participants and the research data be protected with each of the data collection methods?

a)Do you intend to use participant direct quotations in any reports you write (from a survey, interview, focus group, etc.)?

b)If you will use quotations, will participants have the option of refusing to allow the use of direct quotations? If so, please include a signature line in any consent form which states: 'I agree to the use of direct quotations that have had any identifying information of myself or others removed.'

c)Will participants have the opportunity to approve the direct quotations which you will use? If so, please explain how that will happen.

18)What will happen to the research data once the project is complete?

19)If information about the participants is to be collected from other people, describe how this collecting will be done.

20)Describe how you plan to provide feedback from this project to the participants and/or the community to which they belong.

21)Please note any potential changes in methods or procedures that you anticipate during the course of the project.

CREO CONFIRMATION OF COMPLETE SUBMISSION

Organization:

Project title:

Date:

By submitting this form, you are confirming that all of the following documents are included in your initial request for review:

“Request for Ethical Review” Application

Copy of all proposed data collection tools (i.e., survey, interview guide)

Recruitment Materials (posters, text for email messages, etc.)

Phone/Email Script to Invite Participation

Letter of Information

Consent Form (can be combined with Letter of Information)

Please note that we cannot process your application if it isn’t complete.

Applicant’s Name
Applicant’s Signature

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