College of Alice & Peter TanVersion 2.111thJuly 2014

STUDENT RESEARCH PROJECTS - APPLICATION FOR ETHICS REVIEW by the COLLEGE

1Project Title
2 Type of Study / Study Design:
Survey (*with/without re-contact of participants)
Focus Groupsor in-depth interview
Other study design not involving an intervention (specify: ______)
Other study design involving an intervention(specify nature of intervention: ______)
3 Participants / Where will the research be conducted? (Dept and Institution):______
Proposed date of commencement : ______
Total number of participants to be recruited: ______
Mode of recruitment: ______
Does the study population include any of the following groups: children (below 18 years), institutionalized persons (e.g. prisoners), cognitively impaired persons, or any other population considered vulnerable? * Yes / No
4 Informed Consent / Is waiver of documented informed consent required? * Yes/No
If Yes, which of the following apply? (please tick all that apply)
Research involves no more than minimal risk to participants
Waiver or alteration will not adversely affect the rights and welfare of the participants
Whenever appropriate, participants will be provided with additional pertinent information after participation
The research could not practicably be carried out without the waiver
5 Suitability for Department-level Review / Has this been submitted previously for Ethics approval? * Yes / No
(If yes, please provide details separately.)
Which of the following make this proposal suitable for DEC review?
Either :Qualifies for exemption from IRB review (Please refer to IRB Review - IRB-Guide-006 for details)
Educational settings research, educational tests or instructional techniques and methods
Survey without identifiers
Analysis of publicly available data or dataset stored without identifiers
Or:
The probability and magnitude of harm (physical, psychological, social or economic) or discomfort anticipated in the research are not greater than those ordinarily encountered in daily life or during the performance of routine physical or psychological examinations or tests
6Financial Declaration / This study is initiated by the *student / faculty member / commercial company / public institution / non-governmental organization / other ______
Source of funding for study : ______
Amount of Sponsorship / Grant : ______Status of grant: *Approved / Pending / Not applicable
Financial benefits to Subjects (if any) :______
The financial benefits or other benefits derived from this study to Investigators / Department / Institution are as follows: ______
(Please provide a copy of the financial agreement with sponsor company, if applicable.)
7Document Checklist / Mandatory (Please include the following documents in your submission)
Protocol/Proposal**
Copy of the data collection instrument (questionnaire), if applicable
Copy of the information sheet, consent form or recruitment advertisement, if applicable

Please refer to the NUS IRB and College guidelines for information on the types of projects which may be reviewed at the department level. All other projects should be submitted to the NUS IRB.

Applications should be received by the College Office by thethird Friday of the month, and at least three weeks before the proposed start of the project.

8 Declaration by Student Researcher(s)
I declare that the information provided in this application is accurate and as complete as possible. I confirm that the project will only commence after approval is conveyed through my supervisor, and will be conducted in accordance with the protocol unless prior approval has been given by my supervisor.
Name, Matriculation number and signature of student(s) :
______Date : ______
______Date : ______
9 Declaration by Supervising Fellow
This Research Proposal is conducted under my supervision and the information contained in this submission is accurate and complete. I have provided appropriate guidance to the student researcher(s) in the design, methodology and consideration of ethical issues related to the proposed project The study will be conducted in accordance with the protocol, NUS IRB requirements/policies, and all applicable rules and regulations.
1. Significance:
Does the research address an important problem? / YES / NO
2. Approach:
Is the conceptual framework adequately developed? Are the design, methods and analyses adequately developed and appropriate? / YES / NO
3. Innovation:
Does the research challenge existing paradigms, or employ novel concepts, approaches and methods? / YES / NO
4. Student Researchers:
Does the student / team have the appropriate skills and commitment to conduct this research?
Have the necessary steps been taken to safeguard the personal safety of the researchers? / YES
YES / NO
NO
5. Environment:
Is the College environment suited to perform the research? Is there an adequate participant pool and are there adequate resources? / YES / NO
6. Budget:
Are the projected costs appropriate (i.e. accurate)? Is the overall budget reasonable for the significance of the research? / YES / NO
The supervisor is requested to complete the checklist below, which will help in the evaluation of the project.
Signature of Supervising Fellow : Date :
Name of Supervising Fellow :

* Delete as applicable

** Please adhere to the following guidelines when submitting your Research Protocol:

The description of your project should be 1-2 pages in length, and must include:

(1)The background to the current proposal and the overall goal/aims of your research

(2)The specific hypothesis being tested, or the research question you are asking

(3)Who (and how many) your participants will be, and how you intend to recruit them. Please provide inclusion and exclusion criteria.

(4)What data you intend to collect, and how you intend to collect, analyze and store this data

(5)The anticipated benefits and risks to your participants, any ethical issues (e.g. dependent relationships) in your study plan and how you intend to address these

Project Title

For administrative use:

Date received:______

Outcome:

Suitable for department review.

DEC is satisfied that the proposal meets ethical standards and may proceed.

Participants are not a vulnerable group

Involves less than minimal risk

Participants are not identifiable

Revisions needed (attach separate list of revisions)

Not approved. Reasons:

To be referred to Faculty-level committee / NUS IRB.

Reasons:

DEC Chairperson:(name and signature) ______Date: ______

Members: ______

______

Lay/student member: ______

Comments by HoD (if any):

Master / designate: (name and signature) ______Date: ______

Using the following headings, provide a simpleplain English description of your project suitable for a lay person.