Research Participant Request Form (2Nd Semester, 2016-2017)

Research Participant Request Form

Research Participant Request Form (2nd Semester, 2016-2017)

1.  Name of the investigator (Please Print): ______.

2.  Title of project(s): ______.

3.  Contact email address: ______.

4.  Contact phone number: ______

5.  Total number of half-hour units requested: ______

6.  Research participants are being requested for which purpose? (Check one):

___ Faculty Research ___ Postgraduate Research

___ Others. Please specify: ______.

7.  The earliest date you can start running experiments: ______.

8.  Duration of each experiment session ______mins

For experiments less than 15 mins long, you have to collaborate with other experimenter in order to fully utilize the half-hour credit.

Collaborator(s) Name ______

Title of project ______

If you cannot find any collaborators, we can provide a list of other experiments after the deadline of application

9. Language used in your experiments’ material/instruction (Please circle one):

a. English only

b. Chinese only

c. Chinese AND translated English version for non-Chinese speaking students

If only Chinese version is provided, approved by ______(Name of your supervisor)

10. What is the research design of your study?

Experiment / Questionnaire / Other ______

Can you run more than 1 participant per session: Yes / No

If Yes, maximum number of participant per session: ______

11. Does your experiment involve deception? Yes / No

If your study involves deception, have you submitted the Debriefing form to Departmental Research Ethics Committee? Yes / No

Debriefing form approved: Yes / No

Name of supervisor (for postgraduate students only)

______

12. Please be informed that 1) additional incentives (e.g., money) other than credit(s) awarded for the coursework mark(s) in PSYC1001 or 2) sensitive individual feedback (e.g., personality profile or IQ report) should NOT be given to the research participants when using the participant pool system.

How many credit(s) will the participant gain in your experiments? ______

Are there any other additional reward(s)? No _____ Yes ______(please specify)

13. Please fill in the below section if your experiments are run by another person. E.g. RA/student intern

Name of the experimenter (Please Print): ______.

Contact email address: ______.

Contact phone number: ______

Notes

Ø  The participant pool system in the 2nd semester will be operated from Feb 2nd (After the end of add/drop period) to Apr 29th, 2017 (Sat). You can submit your application anytime throughout the second semester.

Ø  To reserve enough credits for everyone when approaching the end of semester, we will set up a maximum quota of 400 half-hour units’ allocation for all experimenters in the initial application. Adjustment may be made subject to actual demand.

Ø  Please submit a completed request form along with a copy of your Research Ethics Approval to Ms Beverly Wong (mailbox no. 48 in the General office C627) or via email attachment (). If requests are made for more than one study, file a separate request form for each study.

Ø  Please fully utilize allocated experimental credits; penalty would be applied in future credit allocation if an experimenter fails to do so. Your experimenter code and password will be sent to you through email within 3 working days after your application.

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