ETHICS APPLICATION FORM
School of Applied Psychology UCC
(adapted from UCC Social Research Ethics Committee documentation)
Introduction
UCC academic staff and postgraduate research students who are seeking ethical approval should use this
application form.
Application Checklist
This checklist includes all of the items that are required for an application to be deemed complete. In the
event that any of these are not present, the application will be returned to the applicant without having been
sent to review. Please ensure that your application includes all of these prior to submission. Thank you.
Completed Application Checklist
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Completed Ethical Approval Self-Evaluation
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Completed Description of Project
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Information Sheet(s)
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Consent Sheet(s)
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Psychometric Instruments / Interview / Focus Group Schedules
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I have consulted the UCC Code of Research Conduct and
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believe my proposal is in line with its requirements
If you are under academic supervision, your supervisor has approved the wording of and co-signed this
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application prior to submission
Name of applicant(s)
Department/School/Unit,
& Supervisor’s Name
Sept 2015
APPLICANT DETAILS
Date
Phone
1
Correspondence Address
Email
Title of Project
ETHICAL APPROVAL SELF-EVALUATION
YES
NO
1 Do you consider that this project has significant ethical implications?
2 Will you describe the main research procedures to participants in advance, so that they are
informed about what to expect?
3 Will participation be voluntary?
4 Will you obtain informed consent in writing from participants?
5 Will you tell participants that they may withdraw from the research at any time and for any reason,
and (where relevant) omit questionnaire items to which they do not wish to respond?
6 Will data be treated with full confidentiality / anonymity (as appropriate)?
7 Will data be securely held for a minimum period of seven years after the completion of a research
project, in line with the University’s Code of Research Conduct?
8 If results are published, will anonymity be maintained and participants not identified?
9 Will you debrief participants at the end of their participation (i.e. give them a brief explanation of
the study)?
10 Will your project involve deliberately misleading participants in any way?
11 Will your participants include children (under 18 years of age)?
12 Will your participants include people with learning or communication difficulties?
Will your participants include patients?
13
Will your participants include people in custody?
14
Will your participants include people engaged in illegal activities (e.g. drug taking; illegal Internet
15 behaviour)?
16 Is there a realistic risk of participants experiencing either physical or psychological distress?
17 If yes to 16, has a proposed procedure, including the name of a contact person, been given? (see no
25)
18 If yes to 11, is your research informed by the UCC Child Protection Policy?
http://www.ucc.ie/en/ocla/policy/
Sept 2015
2
DESCRIPTION OF THE PROJECT
19. Aims of the project (briefly)
20. Brief description and justification of methods and measures to be used. If applicable, please attach
(in APPENDIX 1 below) research questions / copy of questionnaire / interview protocol / discussion guide
/ etc. materials which the Ethics Committee needs to examine in order to evaluate your application.
21. Participants: recruitment methods, number, age, gender, exclusion/inclusion criteria, detail
permissions
22. Concise statement of ethical issues raised by the project and how you intend to deal with them
23. Arrangements for informing participants about the nature of the study (cf. Question 3 above). If
applicable, please attach (in APPENDIX 2 below) the information letter / online statement / other
correspondence you wish to use to inform participants about your study.
24. How you will obtain Informed Consent (cf. Question 4 above). If applicable, please attach (in
APPENDIX 3 below) the consent form you wish to use.
25. Outline of debriefing process (cf. Question 9). If you answered YES to Question 16, give details
here. State what you will advise participants to do if they should experience problems (e.g. who to
contact for help).
26. Estimated start date and duration of project
Signed _____________________________________ Date ____________________
Applicant
Signed _____________________________________ Date ____________________
Research Supervisor/Principal Investigator (if applicable)
Please submit this form and attachments to adminapsych@ucc.ie, with the words ethics
application (followed by your full name) in the subject line). Please include a scan of the
signatures required. No hard copies are required.
This form is adapted from pp. 13-14 of Guidelines for Minimum Standards of Ethical Approval in Psychological Research (British Psychological Soci
July, 2004)
Last update: September 2015
Sept 2015
3
APPENDIX 1.
If applicable, please attach research questions / copy of questionnaire / interview protocol / discussion
guide / etc. materials which the Ethics Committee needs to examine in order to evaluate your application.
APPENDIX 2.
If applicable, please attach the information letter / online statement / other correspondence you wish to
use to inform participants about your study.
APPENDIX 3.
If applicable, please attach the consent form you wish to use.
Sept 2015
4
Authorisation
Date when this research was considered by the Ethics Committee of the School of Applied Psychology
Result (please check one):
Approved
Approved with minor comments (resubmission is not required)
Approved pending clarification (a list of sections and required clarifications must be made below or
appended)
Approved pending approval from external body (the body or bodies from which approval is pending
must be specified)
Not approved
Referred to Social Research Ethics Committee (SREC)
Other
Feedback for the applicant:
Reviewers’ signatures:
Date:
Sept 2015
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