To be completed by the Ethics administrator FEC reference number: Date received: Faculty of Arts and Human Sciences Ethics Committee Application Form Section A 1. Title of project Guidance Please provide a summary of the project Approximately 500 words, must be in lay terms 2. Name of person submitting application Main contact for any correspondence 3. Level of research: UG 4. 5. 6. ☐ PG/T ☐ PsychD Where will the research be carried out? UG and PGT applicants must contact their Faculty Ethics Committee Yes No ☐ ☐ Yes No ☐ ☐ If yes, please state the collaborators in the space provided e.g. another Higher Education Institution (HEI), NHS, Pharmaceutical company If yes, please provide details of the funding in the space provided ☐ Is this project a collaboration with an external body? Is this research funded? Faculty: e.g. University of Surrey, NHS site/s, other HEI Main research site: Other research site/s: 7. Proposed research start date: Expected research end date: (Start and end dates to be included when possible on all displayed posters and advertisements) 1 University of Surrey – Ethics v.3, August 2014 To be completed by the Ethics administrator FEC reference number: Date received: Section B – Recruitment information 1. Where are you recruiting participants from? Guidance e.g. UoS staff and/or students, email, posters, online survey 2. Estimated number of participants: e.g. Travel expenses, entry into prize draw 3. Details of reimbursement to participants: 4. Does your research involve contact with children or vulnerable adults? Yes No ☐ ☐ 5. What are the potential benefits to research participants? 6. Will you be collecting participant’s personal data during the project? Yes No ☐ ☐ 7. I confirm I will retain research data for 10 years, in line with the University of Surrey’s Code on Good Research Practice http://www.surrey.ac.uk/about/corporate/policies/code_on_good_research_practice.pdf If yes, please provide details and a valid DBS Certificate must be shown if required You should state here any potential benefits to be gained by the research participant through taking part in the research either now or in future. However, don’t over-emphasise the benefits. In some cases there may be no apparent benefit. If yes, please provide details. e.g. email addresses, personal addresses, telephone numbers, postcodes ☐ Section C – Document checklist 1. Detailed Protocol Guidance ☐ 2. Participant Information Sheet ☐ 3. Consent Form ☐ 4. Questionnaire (s) ☐ 5. 6. 7. Interview Schedule Recruitment email/advert/poster Risk Assessment (s) ☐ ☐ ☐ 8. 9. Evidence of agreement with other collaborators Relevant insurance documentation ☐ ☐ 10. Other, please state: ☐ Must include ref. number and date Must include UoS logo, ref. number and date Must include UoS logo, ref. number and date If relevant, please include questionnaires for all participant groups Please provide justification if a risk assessment has not been included If relevant If unsure of the relevant documentation please contact [email protected] e.g. DBS confirmation 2 University of Surrey – Ethics v.3, August 2014 To be completed by the Ethics administrator FEC reference number: Date received: Section D 1. I confirm that I have read and understood the Ethical Principles an Procedures for Teaching and Research 2. Guidance ☐ Names and signatures of all investigators (This must be an electronic or wet signature. We cannot accept a typed name in place of a signature) Principal Investigator: The PI should always be the student Academic Supervisor: Co-supervisor (if applicable): Final checks  Please ensure that your documentation has been proof-read before submitting it for the consideration of the Faculty Ethics Committee (FEC). If spelling errors are identified in the initial checks, all documentation will be returned to the researcher. Failing to proof-read study documentation can cause significant delays in the FEC reviewing process  All study documentation must show the reference number and date  Please ensure that you have this application form signed and dated by your Supervisor, we cannot accept a typed name in place of a signature  Please include the relevant insurance documents.  Please note: The Faculty Ethics Committee only requires you to submit one paper copy of this application form and not your entire proposal which should be emailed to the address below as one whole document rather than several attachments, to enable the ethics committee to read and review it quickly and easily. Thank you If you have any questions please contact Julie Earl: [email protected] 01483 68 9175 3 University of Surrey – Ethics v.3, August 2014