Research Ethics New Study Submission Form | Research Office

I. Basic Project Information

Project Title *

Researcher (Lead) *

Mailing Address *

Email Address *

Other Individuals Involved

Name	Affiliation

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Is this project funded? *

Yes No

When is the anticipated start date for this study? *

yyyy-mm-dd

What is the expected duration of the study? *

specify in months or years

Is this a student or graduate project? *

Yes No

Supervisor's Name *

Supervisor's Email *

Supervisor's Affiliation *

II. Purpose of the Research

1. What is the rationale for this study? Describe the research question(s)/objective(s) for the study. *

2. Describe the research methods and instruments used for research. *

III. Participants

1. Describe the study participants. Please provide the inclusion/exclusion criteria as well as how many participants you expect to recruit. Please provide a justification of your sample size. *

2. Provide a step-by-step description of how you will a) identify and b) recruit participants. *

3. Will participants receive any compensation for participating (e.g. honorarium, course credit, food, parking)? *

Yes No

If yes, describe compensation and provide justification for compensation:

4. Does this study involve participants who are not legally or practically able to give their valid consent to participate? *

Yes No

If yes, please indicate how you will recruit participants through those authorized to speak for them. How will you obtain assent from the participants themselves?

5. Are participants from a population that may be marginalized or vulnerable in the context of this research? *

Yes No

If yes, please explain how you will ensure participants do not feel pressure or obligation to participate, or who you will handle other vulnerabilities:

6. Are research team members in any kind of conflict of interest relationship with participants (i.e. students, clients, patients, family members, sponsors)? *

Yes No

If yes, please explain how you will ensure participants do not feel pressure or obligation to participate or perceive that they may be penalized for choosing not to participate.

7. Research involving the First Nations, Inuit and Métis People of Canada:

Will many of the participants identify as First Nations, Inuit, and/or Métis?

Yes No

Will the analysis of the research results use First nations, Inuit, and/or Métis identity as a variable?

Yes No

Will the interpretation of research results refer to First Nations, Inuit, and/or Métis people, language, history or culture?

Yes No

If you answer yes to any of the questions, complete the form Research Involving First Nations, Inuit and Métis Peoples of Canada.

IV. Privacy and Confidentiality

1. How will the identity of research participants be protected during and after the research? *

2. Are there conditions in which the privacy or confidentiality cannot be guaranteed (i.e. focus groups)? *

Yes No

If yes, please explain the precautions you will take to protect privacy and confidentiality:

3. Will participants be given the choice to waive their anonymity? *

Yes No

Please elaborate. A participant's decision to waive anonymity should be explicitly documented, e.g., on the consent form or in a separate release form.

4. Does this research include the use of personal health information? The Manitoba Personal Health Information Act (PHIA) outlines responsibilities of researchers to ensure safeguards that will protect personal health information. *

Yes No

If yes, please contact the Research Ethics Board (REB) chairperson for further instructions.

5. Who will have access to identifying information and how will the lead researcher ensure that all research team members are aware of their responsibilities regarding participants' privacy and confidentiality? *

V. Data Management

1. Describe each type of data you will collect, access, create, store, or share during this study (e.g., audio recordings, paper questionnaires, photos, handwritten notes of observations, a spreadsheet with all participants' questionnaire responses, raw transcripts of interviews, transcripts that have been checked/edited by the participants, edited video-clips, etc.) *

Please identify each type of data you will use. For each type of data:

What type of information will you have (i.e. directly identifying, indirectly identifying, coded, anonymized, anonymous)?
Where will this type of information be stored? If applicable, how will this information be secured during transportation of data?
What precautions will be taken in storing this data and its eventual destruction/disposition?
What will ultimately happen to this data? How long will you keep it? If you will destroy the data, when (specify the year)? If it will be archived or made accessible to the public and/or other researchers, provide details.

Provide the detail for these four questions in the text box below. Add an additional row for each type of data to be used in this project.

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VI. Informed Consent Process

1. Describe the consent process. Where and how will consent be obtained? If consent will not be obtained, justification must be provided. *

2. For participants who are not able to provide their own consent, provide the steps for how informed consent will be obtained. Typically assent forms should be provided for children under the age of 18. *

VII. Deception

1. Will deception be used? Deception refers to the deliberate withholding of essential information or the provision of deliberately misleading information about the research or its purposes. Withholding the hypothesis is not deception. *

Yes No

If yes, provide detailed information on the extent and nature of deception and why the research could not be conducted without it. This description must be sufficient to justify a waiver of informed consent. How will debriefing be provided to participants? When and by whom? Provide justification if debriefing will not be given.

VIII. Feedback

1. Steps should be taken to provide participants with a brief, non-technical summary of research results as soon as possible after the data collection phase of the study is completed should they want it. Provide your plans for providing project results to participants. Participants should be given a choice of how they wish to receive a summary and should be told approximately when to expect it. Request for contact information to supply feedback should be included in the consent form. *

2. If your publications/reports will refer to individual participants, how will they do so (e.g., by their real name, a pseudonym, by a general descriptor)? How will information from or about your participants be represented (e.g., summary statistics for the whole group, direct quotations from their interviews)? *

3. How will the knowledge from this research be disseminated, and to whom? *

IX. Study Withdrawal

1. How and when are participants informed of their right to withdraw? What procedures will be followed for participants who wish to withdraw at any point during the study? *

2. Please indicate what will be done with the participant's data after withdrawal and any consequences which withdrawal may have on the participant. *

X. Risk and Benefits

1. What are the expected benefits of the research? What are the indirect benefits for participants participating in the research? Are there direct benefits for participants participating in the research (if so, what are the benefits)? *

2. What are the risks (psychological, physical, emotional, social, legal, economic, or political) to participants, or to a third party? Provide a description or the risks, the steps that will be taken to reduce or eliminate them, and the steps that will be taken to improve any actually harm to participants, including (if appropriate) providing a list of helpful resources. *

XI. Other Approvals

1. When conducting research with distinct populations, organizational and/or community permission may be required. Will this project require other approval(s)? If so, how will this be obtained? If waiting for permission, provide copies of letters/applications sent to organization/communities. If permission has already been obtained, provide letter(s) of approval. *

If there will be changes to this research, an amendment request must be sent to the REB and approved before changes are made.

Security Confirmation