Low Risk Research Review Checklist
|
|
- Abel Gardner
- 5 years ago
- Views:
Transcription
1 FORM 2 HUMAN RESEARCH ETHICS COMMITTEE Low Risk Research Review Checklist Please complete the checklist below to ascertain whether your research project would be eligible to be submitted to your Faculty Human Research Committee (FHEC) for ethical review as a low risk research. Student researchers must review the completed checklist with their supervisors. If you answer to any items in the checklist your project would normally not be eligible for submission to the appropriate Faculty Human Ethics Committee for review (unless you can make a special case refer section 6) and you should complete an ethics application form NEAF and it to ethics@csu.edu.au for review by the Human Research Ethics Committee. Please note LOW RISK research can be defined as where the foreseeable risk to participants is no more than one of discomfort. For example: questionnaires and/or surveys, anonymous or otherwise, online etc. involving non-sensitive topics observations, with or without consent For more information, refer to the National Statement on ethical conduct in human research 2007 Chapter 2.1: Risk and Benefit. Timing constraints are not an acceptable reason for seeking expedited review through this process where projects are of more than everyday risk. PROJECT TITLE CHIEF INVESTIGATOR Name (Title/ given name / family name) Qualifications Student No(if applicable) address: SUPERVISOR Name (Title/given name / family name) Qualifications School/Research Centre/ External Organisation (of Chief Investigator or supervisor) Level of Study (eg Undergraduate practicum/clinical research project, Honours research project, postgraduate Masters or PhD) Course Subject Title and Code Brief outline of the project (2 lines) LRRC Version 7 1
2 FORM 2 1. EXTERNAL REQUIREMENTS Is the research being funded by an agency outside the University, which requires Human Research Ethics Committee approval involving community representation? [If you have answered to this question you must forward the CSU ethics application form to the Human Research Ethics Committee] Is the project hosted/auspiced by an organisation other than CSU If you have answered No proceed to point 2. Risk Assessment Is the project seen as being owned primarily by the Organisation or CSU If the organisation provide: Name of host organisation Brief outline of the project (2 lines) Approval process followed including committees/position of person(s) approving the proposal Agreement about Intellectual Property of researcher and organisation 2. WAIVER OF CONSENT Will personal information in medical research, or personal information be accessed without first gaining consent from the individual to access this information? If yes is ticked STOP completing this form. Your NEAF application MUST BE SUBMITTED TO the University Human Research Ethics Committee addressing section of the National Statement on Ethical Conduct in Human Research Only a fully constituted HREC may grant waiver of consent for research using personal information in medical research, or personal health information. Other review bodies may grant waiver of consent for other research. Refer section of the National Statement on Ethical Conduct 14_ pdf 3. RISK ASSESSMENT A. Are any of the following topics to be covered in part or in whole? research involving children and young people research about parenting research investigating sensitive personal issues research investigating sensitive cultural issues explorations of grief, death or serious/traumatic loss depression, mood states, anxiety gambling LRRC Version 7 2
3 eating disorders illicit drug taking substance abuse self report of criminal behaviour any psychological disorder suicide gender identity sexuality race or ethnic identity any disease or health problem fertility termination of pregnancy anger management impulse control self esteem domestic violence elderly neglect divorce adults abused as children participant(s) being asked to provide information on another person any similar topic of possible concern use of researcher devised questionnaire researching a sensitive topic (eg.. depression) FORM 2 B. Are any of the following procedures to be employed? use of personal data obtained from organisations (including Commonwealth or State Government Department/Agency) deception of participants concealing the purposes of the research covert observation audio or visual recording without consent recruitment via a third party or agency withholding from one group specific treatments or methods of learning, from which they may benefit (e.g., in medicine or teaching) any psychological interventions or treatments LRRC Version 7 3
4 administration of physical stimulation invasive physical procedures infliction of pain administration of drugs administration of other substances administration of ionising radiation tissue sampling or blood taking collecting body fluid genetic testing/dna extraction use of medical records where participants can be identified or linked drug trials and other clinical trials administration of drugs or placebos potentially humiliating tasks any other similar procedures FORM 2 C. Other Risks Are there any risks to the researcher, (e.g. research undertaken in unsafe, isolated environments or trouble spots)? 4. PARTICIPANT VULNERABILITY ASSESSMENT Does the research specifically target participants from any of the following groups? suffering a psychological disorder suffering a physical vulnerability people highly dependent on medical care minors without parental or guardian consent people whose ability to give consent is impaired residents of a custodial institution unable to give free informed consent because of difficulties in understanding information statement (eg language difficulties) members of a socially identifiable group with special cultural or religious needs or political vulnerabilities those in dependent relationship with the researchers (eg lecturer/student, doctor/patient, teacher/pupil, professional/client) those in a social/personal relationship (eg friendship) with the researcher/s participants able to be identified in any final report when specific consent for this has not been given LRRC Version 7 4
5 Indigenous Australians small sample size which may lead to participant identification in final report any similar vulnerability concerns FORM 2 5. RESEARCH LOCATION ASSESSMENT Location of interviews: interviews being conducted in participant s home interviews being conducted in an isolated area any other similar concerns 6. RESEARCH IN OVERSEAS SETTINGS ASSESSMENT Does the research involve any of the following: research being undertaken in a politically unstable area research involving sensitive cultural issues research in countries where criticism of government and institutions might put participants and/or researchers at risk 7. SPECIAL CASE ASSESSMENT If you have answered to an item in the checklist but you still believe that because of the particular nature of the project and the participants your project may still be eligible for expedited review. Please provide details below, or attach an additional sheet. You must then submit these reasons with the checklist to your Faculty Human Ethics Committee (FHEC) for consideration and approval of your special case. SPECIAL CASE DETAILS: RESEARCHER SIGNATURE: SUPERVISOR S SIGNATURE (if applicable) LRRC Version 7 5
6 FORM 2 APPROVAL BY FHEC OF SPECIAL CASE The FHEC has met and considered the special case details associated with this project and agree / do not agree that the project can be submitted to the Faculty Human Ethics Committee for review. Other comments: FHEC CHAIR SIGNATURE: If you have answered to all items, attach this checklist to your completed NEAF and submit to your Faculty Human Ethics Committee (FHEC). Please note the FHEC may forward your application onto the HREC for review if they deem your research not to be low risk. If you have answered to one item or more and are T requesting a special case your completed NEAF to ethics@csu.edu for review by the full Human Research Ethics Committee. LRRC Version 7 6
DE LA SALLE UNIVERSITY. Checklist A Research Ethics Checklist for Investigations involving Human Participants
DE LA SALLE UNIVERSITY Checklist A Research Ethics Checklist for Investigations involving Human Participants This checklist must be completed AFTER the De La Salle University Code of Research Ethics and
More informationHSPC/IRB Description of Research Form (For research projects involving human participants)
HSPC/IRB Description of Research Form (For research projects involving human participants) This form is to be completed by the Principal Investigator (P.I.) of the research project being submitted to the
More informationApplication for Ethical Approval of Research Proposals
Application for Ethical Approval of Research Proposals Title of Research Researcher s Name Trinity Email Address Supervisor Name (if applicable) Supervisor Email (if applicable) Category of Proposer (please
More informationTHE UNIVERSITY OF HONG KONG Human Research Ethics Committee for Non-Clinical Faculties Application Form for Ethical Approval
50/1011 amended THE UNIVERSITY OF HONG KONG Human Research Ethics Committee for n-clinical Faculties Application Form for Ethical Approval For official use: Ref..: Received date: tes: (1) Please read carefully
More informationRAWALPINDI MEDICAL COLLEGE, RAWALPINDI
RESEARCH UNIT RAWALPINDI MEDICAL COLLEGE, RAWALPINDI APPLICATION FORM FOR UNDERGRADUATE RESEARCHERS Application Number: U R 2 0 1 8 (For Office Use Only, Not to be filled in by the Applicant) INSTRUCTIONS
More informationPhone Numbers: (work) (cell/home) Phone Numbers: (work) (cell/home)
CLARKSON COLLEGE Institutional Review Board (IRB) Application INSTRUCTIONS: Applicants, please complete the following sections accordingly Section 1 and Section IV completed by ALL applicants; Section
More informationThe Chinese University of Hong Kong. Survey and Behavioural Research Ethics
The Chinese University of Hong Kong Survey and Behavioural Research Ethics GUIDELINES FOR SURVEY AND BEHAVIOURAL RESEARCH ETHICS A. Scope Survey and behavioural research covers surveys as well as observation
More informationPROVIDENCE CHRISTIAN COLLEGE INSTITUTIONAL REVIEW BOARD APPLICATION TO USE HUMAN PARTICIPANTS IN RESEARCH
PROVIDENCE CHRISTIAN COLLEGE INSTITUTIONAL REVIEW BOARD APPLICATION TO USE HUMAN PARTICIPANTS IN RESEARCH Before completing this application, please review Procedures for Obtaining Institutional Approval
More informationMelbourne IVF Human Research Ethics Committee. Guidelines for the Review of Quality Assurance, Negligible Risk & Low Risk Studies
Melbourne IVF Human Research Ethics Committee Guidelines for the Review of Quality Assurance, Negligible Risk & Low Risk Studies In most cases, research involving humans requires ethical review. The level
More informationTENNESSEE STATE UNIVERSITY HUMAN SUBJECTS COMMITTEE
TENNESSEE STATE UNIVERSITY HUMAN SUBJECTS COMMITTEE RESEARCH PROPOSAL FORM This proposal is: (check where applicable) Dissertation Research: Grant Proposal: Funding Agency: Master's Thesis Research: Faculty
More informationRESEARCH INVOLVING HUMAN PARTICIPANTS EXPEDITED/FULL APPLICATION
This information listed below should be submitted to Florida Tech s IRB if the proposed research has more than minimal risk (none of the exempt conditions apply) or if the research utilizes a special population
More informationThe University of Queensland Guidelines for Ethical Review of Research Involving Humans
The University of Queensland Guidelines for Ethical Review of Research Involving Humans As part of the design process for any research project involving human subjects or human-related materials, University
More informationMINOR CLIENT HISTORY
MINOR CLIENT HISTORY CLIENT NAME: DATE: FAMILY & SOCIAL BACKGROUND: Please list and describe your child s or teen s current family members (immediate, extended, adopted, etc.) NAME RELATIONSHIP AGE OCCUPATION
More informationHuman Ethics Policy - Research Involving Human Participants v Page 1 of 16
UC Policy Library Human Ethics Policy - Research Involving Human Participants Last Modified October 2014 Review Date March 2015 Approval Authority Deputy Vice-Chancellor (Research) Contact Person Secretary,
More informationType of Review Requested:
Type of Review Requested: FOR OFFICE USE ONLY IRB Protocol # Exempt [Status (see RR 101)] Expedited Full Board For details regarding types of review, please see Levels of Review under FAQ at www.seu.edu/irb
More informationSALISBURY UNIVERSITY COMMITTEE ON HUMAN RESEARCH APPLICATION FOR RESEARCH INVOLVING HUMAN SUBJECTS
SALISBURY UNIVERSITY COMMITTEE ON HUMAN RESEARCH APPLICATION FOR RESEARCH INVOLVING HUMAN SUBJECTS If you have a full committee review: 1. Your proposal must be submitted at minimum 14 days before the
More informationLast Name First name Academic degrees. Professional titles and/or work position within your home institution
Date received stamp ETHICS AND RESEARCH APPLICATION FORM Kenyatta National Hospital/University of Nairobi KEMRI CENTERS ETHICS RESEARCH COMMITTEE Application Number Submit three copies of this form (including
More informationPlease take time to read this document carefully. It forms part of the agreement between you and your counsellor and Insight Counselling.
Informed Consent Please take time to read this document carefully. It forms part of the agreement between you and your counsellor and Insight Counselling. AGREEMENT FOR COUNSELLING SERVICES CONDUCTED BY
More informationMedical gap arrangements - practitioner application
Medical gap arrangements - practitioner application For services provided in a licensed private hospital or day hospital facility (Private Hospital) only. Please complete this form to apply for participation
More informationCLIENT HISTORY CLIENT LEGAL NAME: CLIENT PREFERRED NAME:
CLIENT HISTORY CLIENT LEGAL NAME: DATE: CLIENT PREFERRED NAME: FAMILY & SOCIAL BACKGROUND Please list and describe your current family members (immediate, extended, adopted, etc.) and/or other members
More information2. Definition of Research. 3. When Is Ethics Approval Required? 4. SAE EU Scholarship and Research Ethics Committee Membership. 4.2.
SAE Institute is committed to operating in an ethical way in every area to ensure the highest possible standards of decision-making and accountability. This Code of Practice on Research Ethics sets out
More informationPatient Questionnaire. Name: Date: A. What are the main concerns or problems that brought you here today?
Patient Questionnaire Name: Date: D.O.B.: Age: Referred By: Presenting Problem A. What are the main concerns or problems that brought you here today? B. Problem Checklist: please circle all that apply:
More informationDemographic Information Form
PATIENT INFORMATION Demographic Information Form / / Mailing: Male Female SSN#: - - Home Cell Relationship Status (circle one): Single / Married / Divorced / Widowed / Other: ( ) - ( ) - (Preferred Phone
More informationInstitutional Review Board Application
Institutional Review Board Application Ashoka University values research that is conducted with high standards of scholarship and ethics. The Institutional Review Board (IRB) ensures that the University
More informationDecember Vulnerable Young People Risk Management Procedure
December 2011 Vulnerable Young People Risk Management Procedure 1 1.1 1.2 Purpose of this procedure To provide an effective strategy to respond to vulnerable young people who are at risk due to their own
More informationMDCH IRB REVIEW APPLICATION Authority: Code of Federal Regulations Title 45 Part 46
The Michigan Department of Community Health Institutional Review Board for the Protection of Human Research Subjects Capitol View Building, 7 th Floor, 201 Townsend Street, Lansing, MI 48913 Phone: 517/241-1928
More informationPROCEDURE Mental Capacity Act. Number: E 0503 Date Published: 20 January 2016
1.0 Summary of Changes This document has been redrafted and should be read in full by all officers and staff engaged in providing any response to the public concerning all aspects of Mental Health. This
More informationIRB GRAND ROUNDS SOCIAL AND BEHAVIORAL RESEARCH: NEED TO KNOW
IRB GRAND ROUNDS SOCIAL AND BEHAVIORAL RESEARCH: NEED TO KNOW Vivienne Carrasco, MPH,CIP Senior IRB Regulatory Analyst, Social and Behavioral Sciences Human Subject Research Office University of Miami
More informationINSTITUTIONAL REVIEW BOARD (IRB) PROCESS AND GUIDELINES FOR CONDUCTING RESEARCH AT ORANGE COAST COLLEGE
1 INSTITUTIONAL REVIEW BOARD (IRB) PROCESS AND GUIDELINES FOR CONDUCTING RESEARCH AT ORANGE COAST COLLEGE Developed by: Dr. Eduardo Jesús Arismendi-Pardi Department of Mathematics Sheri Sterner Office
More informationSchool of Natural Sciences ethics application process. Dr. Jane Stout Chairperson of the SNS Research Ethics Committee October 2015
School of Natural Sciences ethics application process Dr. Jane Stout Chairperson of the SNS Research Ethics Committee October 2015 Why have a School Ethics Committee? TCD policy: all research to be conducted
More informationIRB EXPEDITED REVIEW
IRB EXPEDITED REVIEW Research activities that (1) present no more than minimal risk* to human research participants, and (2) involve only procedures listed in one or more of the following categories may
More informationSMART Wokingham Young persons Screening and Referral Form
SMART Wokingham Young persons Screening and Referral Form Referral Source Date: Name of worker: Contact number: Referring Agency: Email address: Client Information Surname First Name Title Previous Name
More informationGymnasium Sign In/Sign Out Sheet. Please sign in before commencing your workout
Gymnasium Sign In/Sign Out Sheet Please sign in before commencing your workout Name Date Time In Time Out Signature Pre Activity Questionnaire Name: 1) Have you undertaken an exercise program before? Yes
More informationHull and East Riding CAMHS Professional Referral Form
Hull and East Riding CAMHS Professional Referral Form 1. Child and Adolescent Mental Health Service professional referral form (CAMHS) Please be aware that this referral form uses Third Party Service Providers,
More informationCAPE PENINSULA UNIVERSITY OF TECHNOLOGY HEALTH AND WELLNESS SCIENCES RESEARCH ETHICS COMMITTEE
CAPE PENINSULA UNIVERSITY OF TECHNOLOGY HEALTH AND WELLNESS SCIENCES RESEARCH ETHICS COMMITTEE HUMAN PARTICIPANTS' REVIEW APPLICATION External Researchers wanting CPUT as a data collection site This application
More informationDemographic Information Form
Demographic Information Form PATIENT INFORMATION Male Female Other / / (Patient Legal Last Name) (Patient Legal First Name) (MI) (DOB) Mailing: SSN#: - - Home Cell Relationship Status (circle one): Single
More informationThe Impact of the Opioid Crisis on Children
The Impact of the Opioid Crisis on Children Guided Notes for Online Learning Name: Date: 1 Table of Contents Section 1: The Opioid Crisis Page 3 Section 2: Addiction Page 4 Section 3: Trauma Informed Care
More informationPsychiatric Residential Treatment Facility Referral
Psychiatric Residential Treatment Facility Referral Psychiatric residential treatment facility (PRTF) referral information Date of referral: Referral contact: Phone number: Referring facility or agency:
More informationProfessional Doctorate in Counselling Psychology
Professional Doctorate in Counselling Psychology Institute of Sport and Human Science Location Study mode Duration Start date Wolverhampton City Campus Full-time 3 year(s) 24/09/2018 Employability Counselling
More informationNova Scotia Board of Examiners in Psychology. Custody and Access Evaluation Guidelines
Nova Scotia Board of Examiners in Psychology Custody and Access Evaluation Guidelines We are grateful to the Ontario Psychological Association and to the College of Alberta Psychologists for making their
More informationHong Kong Psychological Society Division of Counselling Psychology (DCoP) Application Form for Membership
Hong Kong Psychological Society Division of Counselling Psychology (DCoP) Application Form for Membership You are strongly advised to read the Membership Guideline for the membership requirements before
More informationRESEARCH ETHICS POLICY AND PRACTICE AT LEEDS BECKETT UNIVERSITY
RESEARCH ETHICS POLICY AND PRACTICE AT LEEDS BECKETT UNIVERSITY University Research Ethics Requirements Any research project undertaken by staff or students of the university which involves human participants
More informationOne year, many women Taking it to the community: talking health with Victorian women
Introduction One year, many women Taking it to the community: talking health with Victorian women Thanks to funding from the Eirene Lucas Foundation, Jean Hailes is pleased to offer a unique opportunity
More informationRESEARCH ETHICS PROCEDURES
LEEDS BECKETT UNIVERSITY RESEARCH ETHICS PROCEDURES December 2016 www.leedsbeckett.ac.uk RESEARCH ETHICS PROCEDURES Acknowledgments The 2012 review of the Policy and Procedures for Research Ethics at
More informationAWARD CATEGORIES GUIDELINES
Leadership in Family and Community Safety 2017 NOMINATION GUIDELINES ABOUT THE AWARDS The Ministry of Community and Social Services is pleased to present the 2017 Alberta Inspiration Awards in Family and
More informationUsing the NWD Integrative Screener as a Data Collection Tool Agency-Level Aggregate Workbook
Using the NWD Integrative Screener as a Data Collection Tool Agency-Level Aggregate Workbook The NWD Integrative Screener was designed to be user friendly for providers and agencies. Many items and health
More informationGeMS Young Adult Self-Report Questionnaire
Patient Name: D.O.B: MRN: GeMS Young Adult Self-Report Questionnaire This form will help us learn about you prior to your appointment in GeMS. It asks about your gender identity experience, mental health,
More informationCOLLEGE OF SCIENCE, HEALTH AND ENGINEERING DOMESTIC APPLICANTS ONLY
COLLEGE OF SCIENCE, HEALTH AND ENGINEERING DOMESTIC APPLICANTS ONLY 2017 APPLICANT SUPPLEMENTARY FORM Please ensure you include all documents outlined below with your online application Course Application
More informationHASI Orana and Western NSW Application and Referral Form
HASI Orana and Western NSW Application and Referral Form Before starting the referral please ensure you meet the following eligibility criteria for making a referral as below: Psychiatric Diagnosis / functional
More informationAdult Psychiatric Morbidity Survey (APMS) 2014 Part of a national Mental Health Survey Programme
Adult Psychiatric Morbidity Survey (APMS) 2014 Part of a national Mental Health Survey Programme About the Adult Psychiatric Morbidity Survey (APMS) 2014 The Adult Psychiatric Morbidity Survey (APMS) 2014
More informationInternship Application Form
Internship Application Form 2018-2019 Full Name: Applicant Information Last First M.I. Date: Other Names Used (Transcript): Preferred Name: Home Address: Street Address Apartment/Unit # City Postal Code
More informationFORM 3: ATTENTION DEFICIT/HYPERACTIVITY DISORDER VERIFICATION
FORM 3: ATTENTION DEFICIT/HYPERACTIVITY DISORDER VERIFICATION NOTICE TO APPLICANT: This section of this form is to be completed by you. The remainder of the form is to be completed by the qualified professional
More informationRisk Assessment. Person Demographic Information. Record the date of admission.
Risk Assessment The following assessment tool is to be used if the person served has made contact with a behavioral health professional and is willing to work with us, to some degree to assess risk. If
More informationOffice of Research Compliance. Research Involving Human Subjects
Office of Research Compliance Research Involving Human Subjects Office of Research Compliance Three FTE and one student worker Facilitate the IACUC We are not the IRB or the IACUC Best way to contact us
More informationEvidence-Based Practice Fidelity Site Visit Tools
Evidence-Based Practice Fidelity Site Visit Tools This product was supported by Florida Department of Children and Families Substance Abuse and Mental Health Program Office funding. Evidence-Based Practice
More informationClient s Name: Today s Date: Partner s Name (if being seen as a couple): Address, City, State, Zip: Home phone: Work phone: Cell phone:
Client s Name: Today s Date: Partner s Name (if being seen as a couple): Address, City, State, Zip: Home phone: Work phone: Cell phone: Private email address: Student? If yes, where and major? May we leave
More informationProvider Training. Behavioral Health Screening, Referral, and Coding Requirements
Provider Training Behavioral Health Screening, Referral, and Coding Requirements Training Outline I. Behavioral Health Screening Requirements and Referrals II. Healthy Behaviors Substance and Alcohol Abuse
More informationDue Process Hearing Request Information Sheet and Model Form
Oregon Department of Education Office of Learning/Student Services 255 Capitol Street NE Dispute Resolution Section Salem, OR 97310-0203 (503) 947-5689 Due Process Hearing Request Information Sheet and
More informationIRB policy and procedures 1. Institutional Review Board: Revised Policy and Procedures Elmhurst College
IRB policy and procedures 1 Institutional Review Board: Revised Policy and Procedures Elmhurst College IRB policy and procedures 2 Table of Contents A. Purpose and objectives... p. 3 B. Membership of the
More informationJILL L. KOFENDER, PHD, PLLC. Licensed Clinical Psychologist ADULT CLIENT QUESTIONNAIRE. Client s Name Today s Date Gender Age Birthdate
JILL L. KOFENDER, PHD, PLLC Licensed Clinical Psychologist ADULT CLIENT QUESTIONNAIRE Client s Name Today s Date Gender Age Birthdate Cell Phone Is it ok to text? Y N Is it ok to receive appt. reminders?
More informationSelf-Evaluation and Attestation
Legal Provider Name: Agreement No(s): Please submit this completed document with accompanying documentation by: Respond to all statements by placing a checkmark in the applicable box in the Provider Response
More informationSofia P. Simotas, Ph.D., PLLC 2524 Nottingham St. Houston, Texas 77005
Sofia P. Simotas, Ph.D., PLLC 2524 Nottingham St. Houston, Texas 77005 INTAKE FORM Name: Date: Gender: Female Male Date of birth: Address: Home phone: Cell: Okay to leave a message? Yes No Email: Emergency
More informationLast Name First Middle Date of Birth Age. Residence Address City State Zip Code
The following necessary information will help make your first session most productive. Please PRINT and fill out this form COMPLETELY. DEMOGRAPHICS Date: Last Name First Middle Date of Birth Age Residence
More informationADULT INTAKE QUESTIONNAIRE. Ok to leave message? Yes No. Present psychological difficulties please check any that apply to you at this time.
ADULT INTAKE QUESTIONNAIRE Name: Today s Date: Age: Date of Birth: Address: Home phone: Work phone: Cell phone: Ok to leave message? Yes No Ok to leave message? Yes No Ok to leave message? Yes No Email:
More informationAPPLICATION FORM TO BE COMPLETED, PRINTED OUT, SIGNED WHERE APPROPRIATE, SCANNED, AND SENT AS ATTACHMENT TO:
EMDR EUROPE CONSULTANT COMPETENCY BASED FRAMEWORK RATIFIED VERSION WITH CHILD & ADOLESCENT ADDENDUM) APPLICATION FORM TO BE COMPLETED, PRINTED OUT, SIGNED WHERE APPROPRIATE, SCANNED, AND SENT AS EMAIL
More informationAPPLICATION/RESEARCH PROTOCOL REVIEW FORM
APPLICATION/RESEARCH PROTOCOL REVIEW FORM For Research Involving Human Participants Institutional Review Board (IRB) Contact Information: The Office of Research and Sponsored Programs (Billy C. Black Building,
More informationThe AAA statement on Ethnography and Institutional Review Boards (2004) provides a useful working definition:
Ethnographic Research and IRB-SBS Protocols INTRODUCTION The Department of Anthropology has drafted the following guidelines intended to help inform the process of IRB oversight of ethnographic research
More informationMC IRB Protocol No.:
APPLICATION FORM - INITIAL REVIEW INSTITUTIONAL REVIEW BOARD Room 117 Main Building 555 Broadway Dobbs Ferry NY 10522 Phone: 914-674-7814 / Fax: 914-674-7840 / mcirb@mercy.edu MC IRB Protocol No.: Date
More informationCOAHOMA COUNTY SCHOOL DISTRICT Application for Interim Superintendent of Schools
COAHOMA COUNTY SCHOOL DISTRICT Application for Interim Superintendent of Schools (Please type or print your responses and fully respond to each item.) I. BASIC INFORMATION Name: (Last) (First) (Middle)
More informationFull Circle Psychotherapy: Ayla Marie Carter, MA, LMHC
Full Circle Psychotherapy: Ayla Marie Carter, MA, LMHC aylacarter@fullcirclepsychotherapy.org www.fullcirclepsychotherapy.org (253) 686-4681 Name (First, Middle, last): Birthdate: Age: Gender: Sexual Orientation:
More informationGuidance on Benign Behavioral Interventions: Exempt Category Three 45 CFR (d)(3)(i)
Wayne State University Institutional Review Board (IRB) WSU IRB Administration Office 87 East Canfield, Second Floor Detroit, MI, 48201 313-577-1628 irb.wayne.edu Guidance on Benign Behavioral Interventions:
More informationPostgraduate Research Experience 2012 A report on the experience of recent higher degree research graduates
Postgraduate Research Experience 2012 A report on the experience of recent higher degree research graduates Postgraduate Research Experience 2012 a report on the experience of recent higher degree research
More informationGeorgia Office of Dispute Resolution
Georgia Office of Dispute Resolution Application for Mediation Course Approval Specialized Domestic Violence Training for Mediators This application will be considered pursuant to approval criteria established
More informationProtecting Human Subjects In Social-Behavioral-Educational Research:
Protecting Human Subjects In Social-Behavioral-Educational Research: Working with the IRB Lloyd Byrd, MS Chair, VCU IRB Panel E Member, VCU IRB Panel B Monika S. Markowitz, Ph.D. Director, Office of Research
More informationWhen Life Gets in the Way of Living COUNSELLING CLIENT INFORMATION SHEET
GLADEANA McMAHON ASSOCIATES 9 Streetfield Mews, Blackheath Park, London SE3 OER Tel: + 44 (0)20 8852 4854. Fax: +44 (0)20 8852 2038. Email: info@gladeanamcmahon.com Website: www.counsellingpracticematters.com
More informationWelcome to Psychological Assessment Services, LLC. Referral Packet
Welcome to Psychological Assessment Services, LLC Referral Packet 2380 N. 124 th St., Suite 101 Wauwatosa, Wisconsin 53226 Telephone: (414) 443-1773 Fax: (414) 443-1747 E- mail: NealBrey@psychassess.net
More informationChild s name: Nickname: Date of Birth: / / Sex: Male Female SSN: Today s date: / / Parent s Name #1: Home phone: ( ) Cell: ( )
Please fill out the entire form, answering the questions as they pertain to your child or teen. Leave blank any that are unclear or that you want additional clarification on. Thank you. General Information:
More informationPOSTGRADUATE RESEARCH EXPERIENCE A Report of the Postgraduate Research Experience Questionnaire
POSTGRADUATE RESEARCH EXPERIENCE 2011 A Report of the Postgraduate Research Experience Questionnaire Postgraduate Research Experience 2011 A REPORT OF THE POSTGRADUATE RESEARCH EXPERIENCE QUESTIONNAIRE
More informationMonmouth University. V. Workers Assessment (See Appendix)- Only for MSW Second Year CPFC Students
Monmouth University An Empowering, Strengths-based PSYCHOSOCIAL ASSESSMENT AND INTERVENTION PLANNING OUTLINE For Children and Families in the Global Environment I. Identifying Information II. III. IV.
More informationName: Birthdate: Gender: Address: Phone: (Home) (Work) (Cell) Highest Education Attended: Occupation: Place of Employment:
CLIENT CLIENT INTAKE FORM Client Information Name: Birthdate: Gender: Address: Is it safe to send correspondence to this address, if needed? Yes No Phone: (Home) (Work) (Cell) Is it safe to contact/leave
More informationConduct priority and volume investigations (CI101) OCR unit number: 500/8021/0 Level: 3 Credit value: 5 Guided learning hours: 50
Oxford Cambridge and RSA Unit Title: Conduct priority and volume investigations (CI101) OCR unit number: 500/8021/0 Level: 3 Credit value: 5 Guided learning hours: 50 Unit purpose and aim This unit is
More informationWHAT IS THE DISSERTATION?
BRIEF RESEARCH PROPOSAL & DISSERTATION PROCEDURES 2018-2019: (HDIP STUDENTS) Dr Marta Sant Dissertations Coordinator WHAT IS THE DISSERTATION? All HDIP students are required to submit a dissertation with
More informationLevel 2 Award in Understanding Alcohol Misuse
Level 2 Award in Understanding Alcohol Misuse July 2013 6 Guided Learning Hours 10 Total Qualification Time (TQT) Ofqual Qualification Number 600/9949/5 Description: The objective of this qualification
More informationLoss and grief. Unit standard Version Level Credits
Trainee Assessment Loss and grief Unit standard Version Level Credits 23391 Respond to loss and grief in a health or wellbeing setting 3 3 2 Your name: Your workplace: Your date of birth: NSN number (if
More informationYouth Justice National Development Team. Youth Justice National Development Team Annual Report. Fiona Dyer
Youth Justice National Development Team 2012-2013 Youth Justice National Development Team Annual Report Fiona Dyer National Development Team April 2013 0 Annual Report April 2012 March 2013 Youth Justice
More informationASWB LMSW Exam. Volume: 261 Questions
Volume: 261 Questions Question No: 1 Lisa is a social worker who has received a case referred for possible child abuse. She realizes keeping the children safe is her top priority. The household consists
More informationHILLSBOROUGH COUNTY AVIATION AUTHORITY AIRPORT BOARD OF ADJUSTMENT RULES OF PROCEDURE
HILLSBOROUGH COUNTY AVIATION AUTHORITY AIRPORT BOARD OF ADJUSTMENT RULES OF PROCEDURE PURPOSE AND AUTHORITY Adopted May 6, 2010 Revised June 2, 2016 The Hillsborough County Aviation Authority Airport Board
More informationAddress: City/State/Zip: Home Phone: Cell: Pager: Work Phone: Employer/School: Emergency Contact: Phone:
Rock Landing Psychological Group Adult Client Information Please Print Name: Relationship Status: Single Married Domestic Partner Separated Divorced Widowed Date of Birth: Female Male Ethnicity: Address:
More informationJourney to Truth Counseling
ADULT / COUPLE INTAKE FORM (Please Print) Date: / / Social Security # Date of birth: Age: Mr. Ms. Dr. Mrs. Miss. Rev. Full Name (Last) (First) (Middle) Parent/Guardian/Power of Attorney: (if applicable)
More informationMERLE MULLINS COUNSELING REGISTRATION FORM (Please Print) CLIENT INFORMATION
MERLE MULLINS COUNSELING REGISTRATION FORM (Please Print) CLIENT INFORMATION Last Name: First: Middle:! Mr.! Mrs. Today s date: / /! Miss! Ms. Marital status (circle one) Single / Mar / Div / Sep / Wid
More informationQ5 If there is more than one faculty researcher, then enter co-researchers information (Name, address)
IRB Online Submission 2015 Q1 IRB Online Submission for Review Name) Primary Investigator's Name (Last Name, First Q2 E-mail address of primary investigator Q3 Nature of Project Faculty Research Project
More informationPersonal Disclosure Statement and Notice of Practices
Sound Therapy of Seattle Lisa Gormley-Leinster, M.A., LMHC, NCC, CCMHC 200 1st Ave West, Seattle, WA 98119 Phone: (206) 659-1738 www.soundtherapyofseattle.com soundtherapyofseattle@gamil.com Personal Disclosure
More informationAPPLICATION TO INVOLVE HUMAN SUBJECTS IN RESEARCH (Form IAUPRIRB-1)
INTER AMERICAN UNIVERSITY OF PUERTO RICO INSTITUTIONAL REVIEW BOARD APPLICATION TO INVOLVE HUMAN SUBJECTS IN RESEARCH (Form IAUPRIRB-1) TITLE*: PRINCIPAL INVESTIGATOR S NAME, TELEPHONE AND POSTAL ADDRESS*:
More informationCertificate IV in Mental Health Peer Work CHC43515 Scholarships Application Form
Mental Health Coordinating Council (MHCC) Learning & Development ABN 592 791 68647 RTO Code 91296 Certificate IV in Mental Health Peer Work CHC43515 Scholarships Application Form MHCC is offering scholarship
More informationI AA P The Indiana Association for Addiction Professionals
I AA P The Indiana Association for Addiction Professionals Indiana Association for Addiction Professionals Certification Application I. Personal Data Name Date Address City/State/Zip Phone (w) / (h) /
More informationWhat is the Dissertation?
BRIEF RESEARCH PROPOSAL & DISSERTATION PROCEDURES 2017-2018: (HDIP STUDENTS) Dr Marta Sant Dissertations Coordinator What is the Dissertation? All HDIP students are required to submit a dissertation with
More informationPROTECTION OF HUMAN SUBJECTS
PROTECTION OF HUMAN SUBJECTS Human Subjects Policy Statement Lesley University is committed to the ethical principles for the protection of human subjects in research set forth in the Belmont Report of
More informationFlexibility and Informed Consent Process
Flexibility and Informed Consent Process April 30, 2014 Regulatory & Ethical Requirements for Informed Consent Megan Kasimatis Singleton, JD, MBE, CIP Associate Director, IRB Dave Heagerty IRB 8 Coordinator
More informationSummary of Changes to Human Subjects Regulations: Effective January 21, 2019
Summary of Changes to Human Subjects Regulations: Effective January 21, 2019 The New Human Subjects Regulations - What does it all mean? This guide serves to assist Clemson University researchers to understand
More informationStudent Guide To Ethics Review For Research Involving Human Subjects
Student Guide To Ethics Review For Research Involving Human Subjects - Overview - Who needs to get ethics review? - What is human subject research? - What is a Research Ethics Board (REB)? - When and how
More information