Research Participant Request Form
Research Participant Request Form (2nd Semester, 2015-2016)
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: __________
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Research Participant Request Form
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

The participant pool system in the 2nd semester will be operated from Feb 1st (After the
end of add/drop period) to Apr 30th, 2016 (Sat). You can submit your application anytime
throughout the second semester.

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.

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
(beverlyw@hkucc.hku.hk). If requests are made for more than one study, file a separate
request form for each study.

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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