PROTOCOL NUMBER (for office use only): ____________________
University of XXX
Ethics Application Form for Human Research Ethics Committee (HREC Non-Medical)
Instructions
1. This form must be completed by Honours (4th year) and Masters by Coursework and Research Report
students who require ethics clearance, or for ethics clearance for coursework activities as part of a
taught degree.
2. Completed applications must be submitted to the relevant School Ethics Committee.
3. Applications may be submitted as hard or soft (electronic) copies, but the final page of the
application must contain the signatures of the student and supervisor. Final revised versions must be
in soft (electronic) copy as all documentation will be archived.
4. Incomplete or handwritten applications will NOT be considered, including where signatures are
missing.
5. Necessary supporting documents (e.g. Participant Information Sheet, Consent Form, copies of
instruments, permission letters), must be provided.
SECTION A
Complete this checklist to show what documents you have submitted and that you agree with the
conditions of application.
Completed Ethics Application Form.
Copy of the Research proposal.
Copy of proposed Research instruments (e.g. questionnaires/interview schedules).
Participant Information Sheets (for each different sample group and/or instrument used).
Consent forms (for each different sample group and/or instrument used).
Relevant permission letters if required (from, e.g. company's HR department, National
authorities such as Government departments, etc.) - consult the Guidance on the Use of
Permission Letters document.
SIGNATURES (REQUIRED)
Declaration: We, the signatories, declare that all information on this form is correct and that we will
strive to maintain the highest ethical standards in this research at all times, according to disciplinary and
university expectations, recognising that ethical practice in research is always a continuing process.
I recognise that it is my responsibility to conduct my research in an ethical manner Yes No
according to Guidelines of XXX, according to any laws and/or legal frameworks
that may apply, and according to the norms and expectations of my discipline. In
preparing this I have consulted the Guidelines for Human Research Ethics
Clearance Application/Non-Medical and have familiarised myself with the ethical
guidelines specific to my discipline.
By signing this form, the researcher and supervisor of this project undertake to ensure that any
amendments to this project that are required by the Human Research Ethics Committee (Non-
Medical) before the project commences.
Date Name Signature
Applicant
Supervisor
HREC (Non-Medical) Ethics Clearance Application
SECTION B
1. Summary of risk categories of this research project
1.1 I have read and understood the risk categories table Yes No
Applicants must have read the table of risk level category definitions on
the final page of this document
1.2 The applicant must tick the box for the category that best applies to this project:
Risk category Tick the appropriate box
No risk
Minimal risk
Low risk
Medium risk Medium or high risk applications must
High risk be submitted to the University HREC
Applicants must have read the table of risk level category definitions on the final page of this document
1.3 Are participants selected as experts? Yes No
1.4 Will human participant research involve vulnerable categories? Yes No
If YES state which ones:
If YES, how will existing vulnerabilities among research participants be addressed?
1.5 Does this research expose either the participant(s) or the researcher(s)
to any potential risks or harm to which they would not otherwise be Yes No
exposed?
If YES, how will potential risks or harm be addressed?
NB: The term 'vulnerable categories' includes, among others, children under 18, orphans, prisoners, persons with
cognitive or communication disorders, people who are traumatised or currently in traumatic situations. Where
necessary, include details of steps to be taken to facilitate data collection across language barriers (e.g.
interpretation or translation). Vulnerable categories do not necessarily include poor or marginalised communities,
older people, women, or people with disabilities (unless the nature of these participants results in diminished
capacity to give informed consent).
2. Researcher's personal data
Your family name: Your first name:
Title (Mr, Ms etc):
Faculty/Department:
Your student number:
Your email:
Your tel number:
Name of supervisor(s):
Your supervisor’s email:
Your supervisor’s tel
number:
HREC (Non-Medical)
page 2 of 6
HREC (Non-Medical) Ethics Clearance Application
3. Research project
3.1 Title of research project:
3.2 Is this research for degree purposes? Yes No
If so, for what degree?
Honours Masters (research report) Other (specify) _____________________
Full time Part time
3.3 Has it been approved by the relevant higher degrees committee or other relevant unit?
Yes No Submitted and pending
3.4 Will any additional researchers be covered by this ethics protocol (including translators, research
assistants, etc. but not including supervisors)?
Yes No
If yes, please specify their names, affiliations and roles:
3.5 What are the aims and objectives of the research? (Please be specific)
3.6 Summary or abstract of the research (give a brief outline of the research plan such that reviewers can
understand what will be done, 100 words maximum)
3.7 Do you have any financial or material interests or a familial relationship associated with your
research participants or with the organisations that you will be involved with in your research?
Yes No
If yes, please explain how you will manage any existing or potential conflicts of interest, if applicable:
4. Formal permission
4.1 Where will the research be carried out? (Please give a specific location)
4.2 Has appropriate formal permission been obtained, if required (e.g. employer, government department,
5. How willowner,
land data on human research participants be collected (instruments, methods, procedures)? (tick
etc.)?
all applicable boxes) (NB: All applicable instruments must be attached to the application)
Yes (attached) Not required Pending (must be supplied before ethics clearance can be
Hard copy questionnaires or diagnosticgiven)
tests, etc.
Online instruments (e.g. questionnaires, surveys)
NB:Individual interviewsis(e.g.
Obtaining permission structured,
necessary when semi-structured, etc.)
conducting research within the premises of a particular site such as an
Personal communication (e.g. email or informal conversation with
ethnographic study of the functioning of a supermarket or a school, or the wayexperts)
staff interact with clients in a clinic.
Group interviews (e.g. seminar/discussion groups, focus groups, etc.)
Ethnographic observation, participant observation, other informal descriptive, and/or
interactive methods (you must specify in the box below)
Community-based methods or techniques such as drama workshops, community theatre,
training workshops, participant rural appraisal, rapid rural appraisal, etc. (you must specify in
the box below)
Research on/in therapeutic or counselling contexts
Observation of public performance, and/or public behaviour observation
Photography
Video
HREC (Non-Medical)
Audio recording (e.g. of interviews)
page 3 of 6
Other research methods or techniques (you must specify in the box below)
Explanation of ethnographic/participant observations, or other research methods that are not listed:
HREC (Non-Medical) Ethics Clearance Application
6. Who will the research participants be?
6.1 List the different participant groups (e.g. experts, community members, key informants) will you be
working with in your project:
6.2 Description of these participant groups, including age range and sample size, for each group:
7. How will informed consent be obtained?
7.1 How will potential participants be identified / selected / recruited?
7.2 Will any incentives be offered to participants? Yes No
(NB: it is NOT compulsory to offer any incentives)
If YES, please explain:
7.3 How will informed consent be obtained?
Formal (Signed form) Informal (e.g. verbal) Other (e.g. online
If you cannot obtain formal written consent, explain why:
survey)
NB: Attach Participant Information Sheets and Consent Forms for each sample group (please label these carefully),
and/or other related materials. It is essential that participants in research be fully informed (irrespective of the
method used) and then be able to agree on this basis to participate in the research.
8. Protecting participant identities
Can confidentiality of participants be guaranteed throughout the data Yes No
collection process?
Can anonymity be guaranteed throughout the data collection process? Yes No
Can anonymity be guaranteed in resulting research reports or Yes No
publications?
Explain how you will manage issues of anonymity and confidentiality in your project (What will
participants be told in this regard?):
Definitions: Confidentiality: that any information considered confidential by the participant or researcher will not
be disclosed to others. Anonymity throughout the data collection process: that you as the researcher will not be
able to identify the participant. Anonymity in the resulting reports: that the participant’s name/identifying data will
not be disclosed and that anyone reading your results will not be able to identify the participant. NB: While
confidentiality may be desirable, it cannot be guaranteed in, for example, focus groups, or ethnographic
observations. Similarly, anonymity should be preserved in questionnaires, but cannot be offered in workshop
methodologies, focus group research, etc. Participants should have the right to remain anonymous in the final report
and this must be respected in handling of all data relating to them. Participants need to be informed about these
issues through the Participant Information Sheet.
HREC (Non-Medical)
page 4 of 6
HREC (Non-Medical) Ethics Clearance Application
9. Protection of data during and after the research
9.1 How will the data be protected while the research is in progress? (This includes how the identities of
participants will be protected).
9.2 What is to be done with the research data after completion of the project?
Stored in archives (specify below) Stored in online database (specify below)
Stored in password protected Stored in digital form with all identifying features
computer removed
Stored for future secondary Destroyed after … years (insert numbers of years,
analysis if applicable)
Please specify which archives or online databases will be used (if applicable):
n/a
NB: ‘Raw' or unprocessed data, especially where the identity or personal data of research participants is
included, must be safeguarded and preserved from unauthorised access. Data may be destroyed after use, but
preservation in an archive or personal collection may also be appropriate, desirable or even essential. For
instance, datasets that contain historically important information or information that relates to national heritage
must be preserved and should be placed in a public archive where possible and appropriate. All data should be
preserved in a way that respects the nature of the original participants’ consent. If you are unsure about the
procedure of data management and storage, please contact the Data Services Librarian.
HREC (Non-Medical)
page 5 of 6
HREC (Non-Medical) Ethics Clearance Application
10. Summary CV of applicant
ALL boxes in the following table must be completed by the applicant
10.1 List your academic
qualifications. Include
dates or current
registration status
10.2 Describe any ethics
content training you have
previously received (e.g.
ethics short courses;
online courses; ethics
CPD courses; ethical
input as part of a research
methods course)
10.3 List of instruments Hard copy questionnaires or diagnostic tests, etc.
or methods used in this Online instruments (e.g. questionnaires, surveys)
project, as listed in Individual interviews (e.g. structured, semi-structured, etc.)
Section 5 of the
Personal communication (e.g. email or informal conversation with
application form (Tick the
experts)
appropriate boxes and
describe these specific Group interviews (e.g. seminar/discussion groups, focus groups, etc.)
instruments if necessary) Ethnographic observation, participant observation, other informal
descriptive, and/or interactive methods (you must specify in the box
below)
Community-based methods or techniques such as drama workshops,
community theatre, training workshops, participant rural appraisal,
rapid rural appraisal, etc. (you must specify in the box below)
Research on/in therapeutic or counselling contexts
Observation of public performance, and/or public behaviour
observation
Photography
Video
Audio recording (e.g. of interviews)
Other research methods or techniques (you must specify in the box
below)
Explanation of ethnographic/participant observations, or other research
methods that are not listed:
10.4 Describe your
previous experience in
deploying the instruments
or methods of research
which you are applying
here (refer to Section 5
and table in Section 10.3)
HREC (Non-Medical)
page 6 of 6
