/ Human Research Ethics
Request for Annual Renewal of an Approved Protocol

The Request for Annual Renewal form is an institutional protocol based on the

Tri-Council Policy Statement on the Ethical Conduct for Research Involving Humans

Instructions:

1.  Download this Request for Annual Renewal and complete it on your computer. Hand written applications will not be accepted.

2.  Email this form to .

3.  If you need assistance, contact the Human Research Ethics Assistant at (250) 472-4545 or

4.  Annual Renewals are approved for one year.

A. Principal Investigator

Last Name: First Name:

Department/Faculty: UVIC Email:

Phone: Primary Email:

Mailing Address including postal code:

Title/Position: (Must have a UVic appointment or be a registered UVic student)

Faculty Undergraduate Ph.D. Student

Staff Master’s Student Post-Doctoral

Adjunct or Sessional Faculty (Appointment start and end dates):______

Students: Provide your Supervisor’s information:

Name: Email:

Department/Faculty: Phone:

Graduate Students: Provide your Graduate Secretary’s email address:

All PIs: Provide any additional contacts for email correspondence:

Name: Email:

Name: Email:

B. Project Information

Most recent Protocol Number:

Project Title:

Date Recruitment or Data Collection began: Anticipated End Date of Data Collection:

List current and continuing Investigator(s) and Research Team:

(Co-investigators, students, employees, volunteers, community organizations.)

Contact Name

/ Role in Research Project / Institutional Affiliation / Email or Phone

For Faculty Only: Any Graduate Student Research Assistants who will use the data to fulfill UVic thesis/ dissertation/ academic requirements: Include all current Graduate Student Research Assistants

Student/Research Assistant

/ Email or Phone
C. Project Funding

Have there been any changes to the funding of this project since the previous ethics approval (annual renewal or modification)? No Yes

If yes, please complete the following:

Source of Project Funding / Year Applied / Status / Project Title Used in Funding Application (or additional information)
New - Pending
New – Approved
Completed
New - Pending
New – Approved
Completed
New - Pending
New – Approved
Completed
New - Pending
New – Approved
Completed

If you have applied for new funding since the previous ethics approval (annual renewal or modification), have you submitted a funding application or contract notification to the UVic Office of Research Services?

Yes No

Will this project receive funding from US Funders (e.g. NIH)? Yes No

If yes, provide further information:

D. Synopsis of Study Progress

1.  Participant Description

1a. Provide a brief description of the study progress in the last 12 months:

1b. Total anticipated number of participants required for study:

1c. Number of participants completed to date:

2. Unanticipated Events (TCPS 2 Article 6.15)

Have there been any unanticipated issues experienced during the course of the research that have not previously been reported to HREB? This includes any issues that have arisen that may have increased the level of risk to participants or have other ethical implications for the participants welfare that were not anticipated in the approved protocol.

Yes Possibly No

If ‘Yes’ or ‘Possibly’, did you complete and submit an Unanticipated Event Report to the Human Research Ethics office?

Yes No, please explain:

3. Minor Deviations

Provide a brief summary of any minor deviations from the approved protocol that have occurred during the course of the research that do not have ethical implications (i.e. adjustment of testing times, minor wording adjustments in survey questions).

4. Community Engagement (TCPS 2 Articles 9.1, 9.2)

If your research involves Indigenous peoples in Canada (First Nations, Inuit, Métis), is community engagement and consultation ongoing?

Yes No

If ‘Yes’, please provide a summary of your ongoing process. If ‘No’, please explain.

5. Modifications

Changes to the protocol that may have ethical implications or alter the level of risk should be approved via a Request for Modification before being implemented.

If you intend to expand your research goals or conduct additional research activities not currently covered by the approved protocol then you will require a modification or, if the changes are significant enough, a new application.

Do you request to modify any part of your approved protocol?

Yes No

If yes, complete and submit a Request for Modification form. These changes must be reviewed and approved before implementation.

HREB version June 2016

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