Research Application
1. Project Title:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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2. Principal Researcher:
Title: _______________________
Given names: _____________________________________________________________
Surname: ________________________________________________________________
Address: _________________________________________________________________
Suburb/City: _____________________________________________________________
State: ___________________________________________________________________
Post code: _______________________________________________________________
Telephone number (Business): _______________________________________________
Mobile number:___________________________________________________________
Email address: ____________________________________________________________
Facsimile: ________________________________________________________________
3. Associate researchers:
Title: _______________________
Full name: _______________________________________________________________
Organisation: _____________________________________________________________
(If insufficient space, please attach a separate sheet).
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4. Have you previously applied to the ACT Education and Training Directorate for research
approval?
Yes or No: _____________
If yes, please provide file reference: _______________
5. Are you associated with a university, research organisation or research consultancy?
Yes or No: _____________
If yes, name of entity: ______________________________________________________
6. Is the research project commissioned by the Australian Government, such as the
Department of Education, Employment and Workplace Relations?
Yes or No: _____________
If yes, name of entity: ______________________________________________________
7. Is the research project commissioned by an Australian state or territory government?
Yes or No: _____________
If yes, name of entity: ______________________________________________________
8. Is the research project commissioned by an Australian Government Ministerial Council, or
any associated work group such as the Council of Australian Governments or the Standing
Council on School Education and Early Childhood?
Yes or No: _____________
If yes, name of entity: ______________________________________________________
9. Is the research project commissioned by, or developed in collaboration with, the ACT
Education and Training Directorate for evaluation of a program or policy?
Yes or No: _____________
If yes, division/branch/section: _______________________________________________
10. Is the research project a multi-student assignment as part of a course requirement?
Yes or No: _____________
If yes, name of course: _____________________________________________________
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11. Is the research project a requirement for an award of a degree?
Yes or No: _____________
If yes, undergraduate or postgraduate? ________________________________________
Name of course: __________________________________________________________
Name of institution: _______________________________________________________
12. Are you a teacher or employee of the ACT Education and Training Directorate?
Yes or No: _____________
If yes, name of entity: ______________________________________________________
13. Are you undertaking research at your own school or workplace?
Yes or No: _____________
If yes, name of school/workplace: ____________________________________________
14. Have you obtained ethics approval from a Human Research Ethics Committee?
Yes or No: _____________
If yes, please attach document to this form.
If no, complete the ethics statement available from the Directorate’s website and attach
with this form.
15. Does your organisation hold Public Liability Insurance in excess of $10 million?
Yes or No: _____________
If yes, please attach document to this form.
16. Do you intend to publish the research findings in journals or online, or present them at a
conference?
Yes or No: _____________
17. Do you intend to approach?
 All primary schools
 All high schools
 All colleges
 A combinations of schools
Please specify from the list above: ____________________________________________
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_____________________________________________________________________
Please list the specific schools to be approached for the research project.
Note: it is a condition of approval to provide names of all schools that participated in the
project at the completion of the project.
(If insufficient space, please attach a separate sheet).
School/College name: ______________________________________________________
School/College name: ______________________________________________________
School/College name: ______________________________________________________
School/College name: ______________________________________________________
School/College name: ______________________________________________________
18. What is the total time required for schools to participate in the research?
________________________________________________________________________
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19. Do you require the use of Directorate/school resources, for example; classrooms,
computers, internet, phone? Please provide details.
________________________________________________________________________
________________________________________________________________________
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20. Please provide the proposed schedule for major research activities.
(If insufficient space, please attach a separate sheet).
Activity 1: _______________________________________________________________
Starting date: _____________________________________________________________
Completion date:__________________________________________________________
Activity 2: _______________________________________________________________
Starting date: _____________________________________________________________
Completion date:__________________________________________________________
Activity 3: _______________________________________________________________
Starting date: _____________________________________________________________
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Completion date:__________________________________________________________
21. Please provide the number of each participant type (such as principals, executive
teachers, classroom teachers, school-based administrative staff, office-based staff,
students, and parents and carers) for each research activity (such as interviews, focus
groups, online or paper questionnaires etc).
(If insufficient space, please attach a separate sheet).
Participant type 1: ________________________________________________________
Approximate number of participants: _________________________________________
Type of research activity: ___________________________________________________
Participant type 2: ________________________________________________________
Approximate number of participants: _________________________________________
Type of research activity: ___________________________________________________
Participant type 3: ________________________________________________________
Approximate number of participants: _________________________________________
Type of research activity: ___________________________________________________
Participant type 4: ________________________________________________________
Approximate number of participants: _________________________________________
Type of research activity: ___________________________________________________
22. Does the project involve research into potentially sensitive and distressing areas,
including but not limited to the following:
Mental health
Yes or No: _________________
Body image and eating disorders
Yes or No: _________________
Death, grief and trauma
Yes or No: ________________
Anti-social and criminal activities or behaviours
Yes or No: _________________
Ethnicity, race and gender
Yes or No: _________________
Other or similar (please specify): _____________________________________________
If yes to any of the above, please provide a risk management plan outlining the support
services that will be available to participants.
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23. Please provide a brief yet comprehensive description of the major objectives of the
project.
________________________________________________________________________
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________________________________________________________________________
________________________________________________________________________
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24. Please provide a brief yet comprehensive description of the project’s methodology.
________________________________________________________________________
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________________________________________________________________________
________________________________________________________________________
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Declaration
I affirm that:
a) The information provided in this application is correct to the best of my knowledge.
b) My research will comply with ethical and privacy requirements as described in the
documents noted in the Information for Researchers.
c) I will ensure support services, such as clinical or counselling services, are provided to
participants free of charge in the possible case of trauma as a result of participation.
d) I will provide a copy of the research report (papers/thesis/publications) to the ACT
Education and Training Directorate within one month of the project’s completion.
e) I agree to the research report being placed in an online library of the Directorate accessible
to all staff.
f)
All information collected as part of research will not be disclosed to a third party under any
circumstance.
g) All data will always be aggregated to guarantee the anonymity of individual schools,
students and teachers.
h) I will comply with all conditions of the approval letter.
Signature of applicant: __________________________________________________
Name of applicant (please print): __________________________________________
Date: ________________________________________________________________
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