BOC REC Form
Brothers of Charity Services Galway
________________________________________________
Applying for Ethical Approval to Conduct Research ________________________________________________
Please Note: An application can only be accepted for review by the Brothers of Charity Services Galway Research Ethics Committee if it is completed fully and the relevant documentation is enclosed. If you do not submit all the relevant documentation your application will not be processed.
SUBMISSION Checklist
Please indicate if the following have been enclosed by selecting YES/NO/Not applicable options below.
|
YES |
NO |
N/A |
Electronic
Copy of complete
application form.
|
|
|
|
|
|
|
|
Copy of research proposal (No more than 500 words) |
|
|
|
Participant consent form(s) |
|
|
|
Participant information sheet(s) |
|
|
|
Data collection tools, such as interview schedules, sample letters (recruitment etc.), questionnaires, etc.
|
|
|
|
BROTHERS OF CHARITY SERVICES GALWAY
RESEARCH ETHICS COMMITTEE APPLICATION FORM
For Applicant to Complete
|
Applicant’s Name:
|
Title of Research:
For Ethics Committee use only |
||||
Reference number: |
|
Date received: |
|
|
Review Date: |
|
Outcome: |
Approval Provisional Approval Deferral Approval Declined |
|
|
||||
Date Applicant was Informed re outcome:
|
|
|
You must submit your completed by e-mail to the following e-mail address: [email protected]
Please put your answers into the boxes provided and do not alter the format of this form.
Part A: Research Investigator(s)
Note: All correspondence will be sent to the e-mail address of the principal applicant and supervisor(s).
1. Principal Applicant (PA):
Family
Name:
Forename: Title: Email
address (for
correspondence regarding application): Telephone
Number: Present
Appointment of PA:
Staff Title:
Undergraduate
Student (give course title):
Postgraduate
Student (give course title):
Other:
Institution/Employer:
2. Supervisor Details:
Family
Name:
Forename: Title: Email
address (for
correspondence regarding application): Telephone
Number: Present
Appointment: Institution:
Name of supervisor(s):
Contact details of supervisor(s): address, phone number and email address
Present appointment/professional qualifications
3.
Co-Investigator(s), (if applicable):
Family
Name:
Forename: Title: Email
address: Telephone
Number: Present
Appointment: Institution:
Has this proposal been submitted to any other research ethics committee?
Yes No
If yes, which committee and what was the outcome?
|
5. Research funding (if applicable)
a. Details of funding agency and programme
|
6. If applicable, are you covered by Insurance/Indemnity to carry out this research (if unsure please consult your supervisor)
Yes No
Principal
Applicant declaration The
information in this application form is accurate to the best of my
knowledge and I take full responsibility for it. I
understand that it is my responsibility to obtain institutional
approval where appropriate before the project takes place. I
agree to supply a final report to the BOC Galway Research Ethics
Committee from which approval was granted for this project. I
agree to advise the BOC Galway Research Ethics Committee in the
event of premature termination, suspension or deferral of this
project and to provide a letter outlining the circumstances for such
termination, suspension or deferral. Signature
of Principal Applicant:
Date:
Co-Signed
by Supervisor where the P.A. is a Student:
Date:
Part B: Research Proposal
7. Full Title of the proposed research:
|
8. Provide a brief description of research under the following headings:
(no more than 100 words in each section)
the aims/objectives of the study
|
the background to the study (brief overview)
the research design
|
the methods of data collection
|
the size and composition of sample
|
the methods of analysis to be used
|
the proposed starting date and duration of data collection
|
9. Please identify any ethical dilemma(s) which may arise in the course of the study:
|
Part C: Participants: Benefits, Risk, Harm, Selection and Consent
10. Provide details on the participants of the study:
a. Participants. Who will participate in the study?
. |
b. Selection and Recruitment: How will the research participants in this study be selected, contacted and recruited?
|
c. Please state clearly who will contact potential participants?
|
d. Criteria for recruitment/selection of participants
i. Inclusion criteria:
|
ii. Exclusion criteria:
|
Potentially vulnerable participants: If the participants belong to any of the following vulnerable groups please specify (yes/no):
Children under 18 years of age.
|
ii. People who have a recognised or diagnosed intellectual or mental health impairment
|
iii. Older people/the elderly
|
iv. People in residential care
|
v. Persons in unequal relationships with the researcher (teacher/student; therapist/client; employer/employee; staff/service user)
|
vii. Others (please specify).
|
11. If the study participants belong to any of the potentially vulnerable groups: please state what special arrangements will be made to deal with issues of consent/ assent.
|
12. Does the study include participants for whom English is not a first language?
Yes No |
If YES, what arrangements will be made to assist participants to make an informed decision regarding participation:
|
13. Please indicate if there are any potential benefits to participating in this research:
14. Are there any potential risks to participants, for example, could this study cause any discomfort or distress?
Yes No |
If YES, please specify. Please estimate the degree and likelihood of discomfort or distress entailed and the precautions to be taken to minimise them.
Please
specify the risk(s)
Please
state the precautions to be taken to minimise the risk(s)
(Note:
If you are giving contact details for support services for
participants please ensure that you get consent from the relevant
supporting persons/agencies and provide their contact details on the
participant information sheet).
15. Please confirm that the following issues have been addressed in your participant information sheet:
Tick
1. Introductory statement
Researcher’s name and title (Professor, Ms., Mr.)
Name of researcher’s Course/Agency/Employer
The topic and title of the research.
10. How will the data be stored securely and when will it be destroyed?
12. How will participants be told about any further plans for the research outcomes (for example conferences presentation or publication?)
13. Contact details for further information including your details (email and phone number) and the contact details of your supervisor
If any if this information is not included in the information leaflet please explain why:
16. Consent
a. Is written consent required? (please tick)
Yes No |
i. If yes, describe the procedures by which written consent will be obtained.
|
If no, please state why written consent is not required,
(e.g. an anonymous questionnaire).
|
17. Will payment of any kind, including expenses, be made to participants?
Yes No |
If yes, please provide details and justification.
|
18. How long will the participant have to decide whether to take part in the study?
|
Part D: Confidentiality and Data protections
19. What arrangements are in place to ensure that the identity of each participant remains confidential?
|
20. Do you intend to use any of the following recording devices as a means of collecting information for this research study? (please tick)
Audio/Sound recorder Yes No Photography(incl. digital cameras/phones) Yes No Film/Video/DVD recorder Yes No Other (name:_____________________) Yes No |
If yes have you included this information on the participant information sheet?
|
Regarding the measures that will be taken to protect the confidentiality of the data which will be collected:
Who is responsible for the data gathered during the research process?
|
Who has access to the data gathered during the research process?
|
Where will the data be stored? Give details about the security measures that will be put in place to protect the data:
|
For how long will the data be stored? (Please specify if there are institutional requirements in this regard, and if so, what they are).
|
Who will be responsible for destroying the data as per Q21d?
|
Please ensure that you complete the checklist on the front cover of this application form and include all relevant documentation.
THANK YOU.
Page
JESUS’ MOTHER AND BROTHERS MATTHEW 122250 KEY VERSE 1250
MASTER’S MESSAGE BROTHERS I WOULD LIKE TO THANK YOU
MONTHLY UPDATE MARCH 2016 DEAR BROTHERS AND SISTERS IN
Tags: brothers of, etc. brothers, services, galway, charity, brothers