DEPARTMENT OF PSYCHOLOGICAL SCIENCES
BIRKBECK UNIVERSITY OF LONDON
ETHICAL APPROVAL FORM FOR RESEARCH INVOLVING ADULTS (over 16 years)
Please fill out this form carefully and enter ‘X’ in the boxes that apply, below. Please ensure that you
answer EVERY question and that both you and your supervisor (if applicable) sign at the end. Incomplete
forms will be returned and will delay the approval process.
Please enter ‘X' in the boxes that apply and confirm below that you are completing the correct
form:
Yes
A. I intend to carry our research with adults (over 16 yrs)
Yes
B. I intend to carry out research with minors (under 16 yrs)
Yes
C. I intend to carry out research using the fMRI
No
No
No
Please note if you have answered YES to B then you need to complete the form for minors. If you
have answered YES to C then you need to see Fred Dick and apply to UCL ethics committee.
D. Is this application ROUTINE
E. Is this application NON ROUTINE
Yes
No
Yes
No
Please note that all students should discuss with their supervisor whether their application is routine or
non routine. An application is NON ROUTINE if the proposed research raises ethical issues for which the
researcher/supervisor does not have existing ethical approval. An application is ROUTINE if the proposed
study is so close to a previous one which has received ethical approval that there are no new ethical
issues to be considered. If this is the case, the approval number for the approved study MUST be given
below (students should ask supervisors for the appropriate number which is available from the
departmental ethics web pages).
Approval number of all previously related approved applications
Please note that routine applications may be submitted at any time. They are reviewed monthly by the
chair of the ethics committee and you will not receive any correspondence from the committee. Dates for
submitting non-routine applications are on the departmental ethics web pages. For these applications you
will receive a letter informing you of the committee’s decision.
Please submit all applications electronically to ethics@psychology.bbk.ac.uk
Please indicate in the subject title if the application is ROUTINE or NON ROUTINE
Please provide full information
Tick one box:
Staff
Postgraduate
Undergraduate
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Title of Project
Name(s) of
Researcher(s)
Name of supervisor and
programme (for
student research)
Date of Application
Address where approval
certificate is to be sent
(for non routine
projects only)
Email address
Please answer all questions
Yes
1.
Is any other ethics committee involved?
No
If YES please provide details of the committee and the stage of process/decision made. All relevant
documentation must be attached.
2. Give a brief description of the aims/objectives of the research
3. Give a description of the participants (recruitment methods, number, age, gender,
exclusion/inclusion criteria etc). Please attach relevant recruitment documents such as leaflets,
letters, notices etc.
4. Where will the research be carried out?
5. Give a brief but FULL description of what participation in the research will involve (methods,
procedures, time involved in participation, equipment, facilities etc) in up to 500 words. Please
include details of how you will debrief participants and ensure there have been no adverse effects.
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6. Give a brief description of tests, questionnaires, interview schedules etc. Non standard procedures,
questionnaires and indicative interview schedules must be attached. If appropriate, please address
any ethical issues raised by the content of questions (eg sensitive topics which might cause
distress) and explain why their use is justified.
7. Please attach documentation for informing participants about the study prior to obtaining their
consent. This should include (a) information about the proposed study (in lay terms), (b) details
about the researchers including how they can be contacted (and names and contact details of
supervisors if appropriate), (c) confidentiality of the data and right to withdraw, (d) any risks
involved, (e) anything else that participants might reasonably expect to know in order to make an
informed decision about participation. Please indicate how this information will be given (eg letters
to each participant, displayed on a computer screen, header of questionnaire). A template
information sheet is available at the end of this form which should be modified for appropriate use
in the proposed study.
Documentation attached (tick box):
8. Please attach documentation for participation consent arrangements. A typical checklist might
include that (a) their participation is voluntary; (b) they are aware of what participation involves;
(c) they are aware of any potential risks; (d) their questions concerning the study have been
answered satisfactorily. The researcher should talk through consent with the participant and both
should sign two copies (one to be kept by the participant, one to be retained by the researcher). A
template consent form is available at the end of this form which should be modified for appropriate
use in the proposed study. Please note that when using online/postal questionnaires completion of
questionnaire indicates consent
Documentation attached (tick box):
In addition, if using interviews it is good practice to record
discussion of consent and information arrangements.
Tick the box to confirm this will be done:
9. Give a brief description of how participants will be assured that all information given will be treated
with the utmost confidentiality and their anonymity respected. Please include how (a) any
identifying information will be kept separate (if possible) from the data (eg coding the data and
keeping the key which links codes and participants’ identity separate); (b) where data will be
stored (especially identifying information); (c) who will have access to the data; (d) what use will
be made of the data. In addition, if using interview data please describe how you will ensure that
all identifying information is removed from the transcripts (eg the use of pseudonyms and changing
of location, occupation etc).
10. There is a duty of care on researchers to avoid any adverse effects of their research on
participants. Please answer the following questions (A-I). If you have ticked YES to any of them,
please give an explanation below.
DOES THE RESEARCH INVOLVE:
YES
NO
N/A
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A
Unpleasant stimuli and/or situation
B
Invasive procedures
C
Deprivation or restriction (eg. sleep, food,
water)
D
Drug administration
E
Any other procedure which might cause
harm/distress
F
Vulnerable participants whose
physical/mental health might be at risk
G
Actively misleading or deceiving the
participants
H
Withholding information about the nature
or outcome of the research
I
Any inducement or payment
11. If you think that there is any realistic risk of participants experiencing either physical or
psychological distress or discomfort (due to the nature of the topic or form of data collection),
please give details and describe what safeguards you will put in place. These might include what
you will do if participants become distressed and information on who they can contact for help and
support. NB If using qualitative in-depth interviews this question must be addressed.
12. Please describe any other issues with ethical implications not covered by the above questions
If you are the RESEARCHER please enter ‘X’ in the boxes that apply, below, and
sign/date the form
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I CONFIRM THAT
YES
NO
N/A
The proposed research should be considered routine and the
relevant approval number has been provided
The proposed research should be considered non-routine
All documentation regarding participant information
arrangements is attached
All documentation regarding participant consent information
arrangements is attached
All non standard procedures, questionnaires and indicative
interview schedules are attached
I consider the proposed research conforms with ethical
practices in psychological research
PLEASE SIGN ELECTRONICALLY BELOW BY TYPING YOUR FULL NAME. THIS ELECTRONIC
SIGNATURE REPRESENTS YOUR HAND-SIGNED SIGNATURE
SIGNATURE OF RESEARCHER
DATE
_________________________
_____________
If you are the SUPERVISOR please enter ‘X’ in the boxes that apply, below, and
sign/date the form
I HAVE READ THE APPLICATION AND CONFIRM THAT THE PROPOSED RESEARCH
YES
NO
Addresses all ethical issues
Be considered routine because it raises no ethical issues beyond those of a study I
have already received departmental ethical approval
Has the appropriate ethical approval number
Be considered non routine and should be reviewed by the ethics committee
PLEASE SIGN ELECTRONICALLY BELOW BY TYPING YOUR FULL NAME. THIS ELECTRONIC
SIGNATURE REPRESENTS YOUR HAND-SIGNED SIGNATURE
SIGNATURE OF SUPERVISOR
DATE
_________________________
_____________
Template information sheet to be modified to fit proposed study
DEPARTMENT OF PSYCHOLOGICAL SCIENCES
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BIRKBECK UNIVERSITY OF LONDON
Title of Study:
Name of researcher:
Please ensure the title is informative and user-friendly
xxxx xxxxxx
Please ensure that the information sheet describes in full what participation in the study will involve
(including any procedures, time involved etc.) and avoiding technical jargon.
Dear X
The study is being done as part of a degree in the Department of Psychological Sciences, Birkbeck
University of London. The study has received ethical approval.
This is a study of how people remember things. If you agree to participate you will take part in a study
which involves watching words appear on a computer screen and afterwards remembering as many of the
words as is possible. The procedure will take about 15 minutes. You are free to stop the study and
withdraw at any time.
A code will be attached to the data so it remains totally anonymous and all information will be treated with
the utmost confidentiality.
The results of the study will be written up in a report of the study for my degree. You will not be
identifiable in the write up or any publication which might ensue.
The study is supervised by …........ …….If you wish to contact the supervisor, contact details are:
Supervisor’s email address
Departmental address: Department of Psychological Sciences, Birkbeck University of London, Malet St,
London WC1E 7HX TEL: 020 7079 0868
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Template consent form to be modified to fit proposed study
DEPARTMENT OF PSYCHOLOGICAL SCIENCES
BIRKBECK UNIVERSITY OF LONDON
Title of Study:
Name of researcher:
Please ensure the title is informative and user-friendly
xxxxx xxxxxxxx
I have had the details of the study explained to me and willingly consent to take part.
My questions have been answered to my satisfaction and I understand that I may ask further questions at
any time.
I understand that I will remain anonymous and that all the information I give will be used for this study
only.
I understand that I may withdraw my consent for the study at any time and to decline to answer any
particular questions.
I agree/do not agree to the interview being audio recorded.
I understand that I have the right to ask for the audio recording to be turned off at any time during the
interview.
I confirm that I am over 16 years of age.
Name…………………………….
Signature………………………….. (Participant)
Name…………………………..
Signature…………………………… (Researcher)
Date…………………………..
There should be two signed copies, one for the participant, one retained by researcher for
records
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