For official use
Reference No.:
THE SCHOOL OF PSYCHOLOGY, SOUTH CHINA NORMAL UNIVERSITY
Human Research Ethics Committee for Non-Clinical Faculties
Application Form for Ethical Approval
Please complete Parts A - B and F – H. If you are collecting new data, please also complete Part C.  If you are studying existing personal data, document or records, please also complete Part D. If you are collecting new data, and seeking a waiver of informed Consent, please also complete Part E. 
Part A: Summary
Principal Investigator
(                  )* Surname:
First Name:
Department: 
Position / Staff Grade:
Staff No.:
Office telephone:
PI email:
For students, please provide the following additional information:
Degree Programme/Year:
SCNU Student No.:
Name of Supervisor:
Supervisor email:
Co-Investigator(s), if any
Name:
Staff No:
Position:
Department/Unit:
Degree Programme/Year (for students only):
Name:
Staff No:
Position:
Department/Unit:
Degree Programme/Year (for students only):
Name:
Staff No:
Position:
Department/Unit:
Degree Programme/Year (for students only):
Research Proposal/Project:
Title: 
Start date:
Expected completion date:
Funding Source (please tick as appropriate):
University internal research grants#
RGC General Research Fund
Innovation Technology Fund
Public Policy Research
Contract Research#
Other external grant#
No funding
# Please specify funding source: _ Faculty Research Fund ________________________________
*Delete as appropriate
Part B: Research Proposal
Please summarise on ONE page the objectives of the project and methodology used, and attach a copy of your proposal including any questionnaire and informed consent form to be used.
Objectives of the proposal:
Research plan and methodology:
Part C: Risk Assessment for Newly Collected Data
Please answer the following questions, if your proposal involves any newly collected data, to decide if your proposal should be submitted for expedited review.
Yes
No
a)  Will the study involve action/participatory/treatment research?
b)  Is it possible that the study will involve greater than minimal privacy risks, which could induce stress to research participants, such as political behaviour, illegal conduct, drug or alcohol use and sexual conduct?
c)Is it possible that the participants’ burden to complete the procedures will induce greater than minimal stress, in particular, for children, given their age and capacity?
d)Is it possible that the study will induce greater than minimal physical or psychological stress/pain/discomfort?
e)Is it possible that the study will expose participants to greater than minimal physical or medical risk?
f)Will deception be used during the study?
g)Will video-recording be used during the study?
h)Will audio-recording be used during the study?
i)Is there potential conflict of interests? (e.g. financial gain to the investigators, power over participants such as teacher/student relationship)
j)Will the study involve vulnerable participants who are unable to give informed consent, e.g. under the age of 18, mentally handicapped individuals?
- If “Yes”, please specify details of the age group and/or vulnerability:
      _______________________________________________________
(Parent/Guardian Consent Form should be attached.)
For Expedited Review:
- If you have answered “No” to all of the questions (a) – (j) above, your application may qualify for an expedited review, meaning that your research involves minimal risk. However, informed consent is still required unless reasons why this is infeasible are adequately justified.
For Full Review:
- If you have answered “Yes” to any of the above questions (a) – (j), please give more details on your study design and methodology in the questions (k) to (t).
k)The selection and recruitment of participants (Attach any initial letter of contact and Consent Form)
     
l)Rationale for sample size calculation
     
m)How will participants be recruited/identified？
           
n)What are the inclusion and exclusion criteria?
o)Description of any specific data collection, such as interviews, questionnaire (including telephone) survey or experimental procedures like deception (please attach Deception Form) and any treatment or intervention.
p)Please state who will perform the data collection, how long it will take and where the data collection will take place.
q)Can the participants be allowed to withdraw at any time without prejudice?
r)Will there be any stress/discomfort to participants?
s)Please provide details of any audio and/or video recording including the justifications for the recording.
       
t)Please identify any potential conflict of interests and how that potential conflict will be addressed.
Part D: Using Existing Documents or Records containing Personal Data
Please complete this section if you are using existing documents or records that contain any personal data.
Will existing documents or records containing any personal data be used?        Yes          No
- If “Yes”, please give more details of the personal data being obtained by answering questions (a) – (h) in the following.
- If “No”, please skip this Part D.
a)What is the source of the data?
b)    Were the data originally collected for research purposes?          Yes          No
minimal
-
If “Yes” is checked, please attach a copy of the Consent Form for the original collection of data.
-
If “No” is checked, please provide the Personal Information Collection Statement.
-
For all situations, please explain how this research is consistent with the purpose and use specified when the data were originally collected.
c)    Please list the types of personal data being used, if not already listed in the Consent Form for the original collection of data or Personal Information Collection Statement.

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