STUDENT COURSE-BASED RESEARCH ETHICS
APPLICATION FORM
Complete this form only when instructed by your professor/instructor and if you are the
principal investigator of your research team. Please refer to the Student Course-Based
Research Ethics Application Guide as it will provide further information and guidance to
complete this form. Answer all questions and do not leave any blanks. If not applicable, type
N/A.
Date: Click here to enter a date.
LAM#: Click here to enter text. (For Office use only)
SECTION A: GENERAL INFORMATION
Student Information
Student Principal Investigator:
Program of Study:
Telephone:
E-mail:
Course Information
Course Title:
Course Code:
Professor/Instructor:
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Project Information
Assignment Title:
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Student Project Title:
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Other Students Researchers: Click here to enter text.
SECTION B: GENERAL PROJECT INFORMATION
1. How does your project link to the assignment outcomes?
Please Explain:
SECTION C: RESEARCH INFORMATION
2. Where will the research be conducted?
Please Explain:
Who will the research participants be?
Please Explain:How many participants are expected to participate?
Please Explain:How will the participants be recruited and selected?
Please Explain:
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STUDENT COURSE-BASED RESEARCH ETHICS
APPLICATION FORM
3. What research instuments/ materials will be used (eg. surveys. observations tracking sheet,
etc.)? Attach all final tools to be used.
Please Explain:
4. What are the steps research participants will be involved in (eg. tasks, activities, testing,
interviews, surveys, etc.)? Please include time requirements in your description.
Please Explain:
SECTION D: RISKS & CONFLICT OF INTEREST
5. Will there be any perceived or anticipated risks/ conflicts of interest or potential for risks/
conflicts of interest.
☐ Yes
☐ No
a. If YES, please describe the risk(s) and/or conflict of interest(s) and the actions you
will take to manage them.
Please Explain:
SECTION E: CONSENT PROCESS & FEEDBACK TO PARTICIPANTS
6. How will the participants be informed of any risks, procedures and information about the
research project? Attach all final forms, letters, email text, scripts to participants.
Please Explain:
7. Will participants have the right to stop participating at any time without penalty?
☐ Yes
☐ No
a. If NO, please provide details why.
Please Explain:
SECTION F: PRIVACY & CONFIDENTIALITY
8. Can any participant be identified by the collection of data?
☐ Yes
☐ No
a. If YES, please describe the identifiable data to be collected.
Please Explain:
9. How will confidentiality and privacy of the participants be protected?
Please Explain:
SECTION G: DOCUMENTS FOR SUBMISSION
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STUDENT COURSE-BASED RESEARCH ETHICS
APPLICATION FORM
10. To avoid delays, the following documents shall be submitted along with this application:
Required Documents
A. Proof of research ethics training for all researchers (TCPS2 certificate)
B. Final letters of information/ consent forms
C. Final Recruitment Materials (eg. posters, email, telephone scripts)
D. Final Research Instruments (eg. surveys, questionnaires, tests)
Attached
☐ Yes
☐ Yes
☐ Yes
☐ Yes
Below list other documents being submitted that are not listed above.
A. Click here to enter text.
B. Click here to enter text.
C. Click here to enter text.
11. Please provide an explanation if any of the above mentioned documents are not attached.
Click here to enter text.
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STUDENT COURSE-BASED RESEARCH ETHICS
APPLICATION FORM
SECTION H: SIGNATURES
☐ By checking this box and sending an electronic copy through my Lambton College email
account, Click here to enter text. ; I, Click here to enter text. , certify that it will serve as
my official digital signature; and that I acknowledge, understand, and agree to the
statements below (I-V).
Please check to acknowledge that you agree with the following:
☐ The information provided in this form is accurate.
I. ☐ My research team and I will not begin the recruitment and or collection of data prior
to receiving approval from my professor/instructor.
II.
☐ I will report any changes to the research protocols/final documents or unanticipated
events immediately to my professor/instructor.
III.
☐ I will conduct research with the highest ethical standards according the College’s and
TCPS 2 (2014) guidelines.
IV. ☐ I will seek the guidance, advice, and assistance from my professor/instructor
regarding the ethical conduct of research.
Submission Instructions: Please email the completed application and all supporting
documentation to your instructor by the specified due date.
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