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Application for Review by the College Human Ethics Advisory Network (CHEAN) of “Exempt from review” Research[1]

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About this form:

This application form should be used by researchers seeking ethics approval from the CHEAN for human research projects that have been assessed by the RMIT HREC “Checklist for exempt from review / negligible and low risk research” as exempt from review.

The completed checklist must be attached as a cover to this form

Attachments:

You need to include with this application the following supplementary documents

  • A completed “exempt from review” checklist
  • A copy of the written permission to access the non-identifiable data set.

Submitting the application form:

Submit your original and signed application form as well as any supplementary information to your relevant CHEAN secretary. Please go to your college website to ascertain where to send your documents and how many copies you will be required to submit. All initial correspondence about your application should go through the CHEAN secretary.

You must not commence data collection until you receive written approval from the CHEAN

Please remove this cover page before submitting your application

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Application for Review by the CHEAN of “Exempt from review” Research[2]

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Application Number
(office use) / Approval Date
(office use)
1PROJECT TITLE

Section 2: Researchers

2.1PRINCIPAL INVESTIGATOR – STAFF RESEARCH
Title / First name, family name / phone / email
2.2OTHER INVESTIGATOR/S
Title / First name, family name / phone / email
Add rows as required
2.3PRINCIPAL INVESTIGATOR – STUDENT RESEARCH DEGREE
Title / First name, family name / phone / email
2.4SENIOR SUPERVISOR
Title / First name, family name / phone / email
2.5OTHER INVESTIGATOR/S
Title / First name, family name / phone / email
Add rows as required

2.6DISCIPLINE/SCHOOL/COLLEGE:

3.PROJECT DETAILS

3.1 / PROPOSED DURATION OF the whole RESEARCH PROJECT / From: / To:
3.2 / PROPOSED DURATION FOR the DATACOLLECTION phase OF the RESEARCH PROJECT / From: / To:

Please note: it is a requirement that annual / final reports of your project must be submitted and are due during December for all research projects that have been approved by the CHEAN

The necessary form can be found at:

3.3in plain english PROVIDE A SUMMARY OF THE RESEARCH PROJECT

See NHMRC National statement on ethical conduct in human research (2007), section 1

Include in your summary; the aims, research objectives, key research questions, significance of the project and possible outcomes. Briefly describe the method of data analysis (300-400 words)

4.DECLARATION BY RESEARCHERS

I/We have read the NH&MRC National Statement on Ethical Conduct in Human Research (2007), and accept responsibility for the conduct of the research detailed in this application in accordance with the principles contained in the National Statement and any other conditions laid down by the relevant RMIT Human Research Ethics Sub-Committee.

Name: / Date:
Please print / (Signature of Principal Investigator)
Name: / Date:
Please print / (Signature of other investigator or senior supervisor if applicable)

Copy, paste and complete additional signature boxes to enable all co-investigators to sign.

Declaration by the Supervisor (if not an investigator)

I have informed the student of their responsibility to undertake this research in a manner that conforms with the NH&MRC National Statement on Ethical Conduct in Human Research 2007, and any conditions of approval of this research by the RMIT College Human Advisory network.

Name: / Date:
Please print / (Signature of Senior Supervisor)

Declaration by the Head of School:

The project set out in the attached application, including the adequacy of its research design and compliance with recognised ethical standards, has the approval of the School. I certify that I am prepared to have this project undertaken in my School/Centre/Unit.

Name: / Date:
(Signature of Head of School or approved delegate)
School/Centre: / Extn:

Version 2 2010

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[1] Adapted from Queensland Government, Queensland Health “Application for review (HREC or Non-HREC) of low risk research” 2008

[2] Adapted from Queensland Government, Queensland Health “Application for review (HREC or Non-HREC) of low risk research” 2008 and “low impact research”, SET Portfolio, 2008