This form certifies that a low risk project involving the participation of humans is in full compliance with Policy 4.1.1Participation of Humans in Research – Low Risk.
Region / School District #39 (Vancouver)Project Title
First Name / Last Name / Email / Phone
Student 1
Student 2 (if applicable)
Chair, VDSF1
Chief Judge, VDSF1
Adult Supervisor
Request for Ethics Approval by the Adult Supervisor
I have visited and understood the web site of the YSC National Ethics and Safety Committee:
I have read and understood Policy 4.1.1Participation of Humans in Research – Low Risk
Signed - Student 1DateSigned - Student 2Date
Ethics Approval
I certify that this Low Risk Project involving Human Participation is in full compliance with Policy 4.1.1 Participation of Humans in Research – Low Risk, and that it is eligible for the Vancouver District Science Fair,Regional Science Fair and the Canada Wide Science Fair.
Signed – Adult SupervisorDate
1 Or Designate
Form 4.1A Participation of Humans – Low Risk
Instructions
1)Form 4.1A
This form certifies that a low risk project involving the participation of humans is in full compliance with Policy 4.1.1 Participation of Humans in Research – Low Risk
2)Documents
The following documents must be available to the Adult Supervisor:
a)Form 4.1A
b)The Survey – if your project involves a survey
c)Your Letter of Information for every participant in your survey
d)A blank sample of the Informed Consent form that each participant will sign
3)Instructions for Participants in the District Science Fair
a)Fill in Form 4.1A on a computer, not by hand.
b)Print the completed Form 4.1A and then get it signed with all the required signatures.
c)Make a paper copy of the completed and signed form.
d)Store the original signed copy in a safe place.
e)Take the copy of the signed form 4.1A to your District Science Fair.
f)If you did a survey, take these three forms to your District Science Fair as well:
i)The survey
ii)The letter of Information that you gave to each participant in your project.
iii)A blank sample of the Informed Consent Form each participant signed before they did your experiment.
4)Instructions for Participants in the Regional Science Fair
Follow the same instructions as for the District Science Fair, but submit out a new Form 4.1A as the Chair and Chief Judge will be different people.
5)Instructions for the Finalists selected for the Canada Wide Science Fair
a)Scan your original completed and signed form from the Regional Science Fair and format it as a pdf file. To learn how to convert your scanned image to a pdf file, type phrases such as “Scan to pdf file’ into your favourite search engine.
b)Upload it as part of your Registration for the CWSF
c)If you did a survey, upload these forms as well, in pdf format:
i)The survey
ii)The letter of Information that you gave to each participant in your project.
iii)A blank sample of the Informed Consent Form each participant signed before they did your experiment.
Youth Science Canada Form 4.1AHuman Participation – Low Risk