ࡱ>       ] 9bjbj\\ A6i6iSb#$#$#$#$#$7$7$7$8o$c)7$07,K@a@a@a@)E( QN\Q$Ln=#$]SDD^]S]S=#$#$a@a@jhhh]S#$a@#$a@h]Shha@Wl00pZ pp#$l]S]Sh]S]S]S]S]S==d*]S]S]S0]S]S]S]Sp]S]S]S]S]S]S]S]S]SY ":   Template Not for submission  This is a working template of the standard application and is only intended to help with research team collaboration in preparation for online submission or course-based projects. To submit a research ethics application for review and approval by the Human Research Ethics Office you must login to Research Administration Information System  HYPERLINK "/userais/" UVic-RAIS (HYPERLINK "/research-services/info-for/rais-login-and-support/index.php"/research-services/info-for/rais-login-and-support/index.php ) and complete the online form. Useful resources referred in application: HYPERLINK "/research-services/how-do-i/get-ethics-approval/how-to-apply-human-ethics-approval/index.php"UVic Human Research Ethics webpage HYPERLINK "/research-services/how-do-i/get-ethics-approval/how-to-apply-human-ethics-approval/standard-application-guidelines/index.php"Annotated guidelines HYPERLINK "/research-services/_assets/docs/research-resources/hre-consent-form-template.doc"Consent form template HYPERLINK "https://ethics.gc.ca/eng/policy-politique_tcps2-eptc2_2022.html"Tri-Council Policy Statement TCPS2 HYPERLINK "https://tcps2core.ca/welcome"TCPS2 Core Tutorial HYPERLINK "/research-services/how-do-i/get-ethics-approval/how-to-apply-human-ethics-approval/dual-role-research-guidelines/index.php"Dual-role guidelines HYPERLINK "https://healthresearchbc.ca/research-ethics-bc/info-and-resources/information-for-researchers/"Research Ethics BC A. Research Team If there is more than one Principal Investigator, provide their name(s) and contact information below in Section A.3. Research team members. Principal Investigator (faculty, faculty supervising a student or post-doctoral researcher) Principal Investigator is a faculty member, adjunct professor or sessional instructor. For more information please see theannotated guidelines. If the project has more than one Principal Investigator (other than you) or more than one Principal Applicant, their names should be listed under HYPERLINK "/rais/research/editApplication?appVersionId=2462" \l "q14-row" section A.3Research Team Members. Name:  FORMTEXT       Principal Investigator Department:  FORMTEXT       Principal Investigator Position :  FORMTEXT       2. Principal Applicant (students & post-docs) For further information about the distinction between the Principal Investigator and Principal Applicant, please see theannotated guidelines. A Principal Applicant is an undergraduate student, graduate student or post-doctoral fellow who will be the lead researcher (for their thesis, dissertation, project, etc.) for this study. A Principal Applicant will be granted "View and edit" access by default, and will receive notifications related to the study. If the project has more than one Principal Applicant, the additional individuals should be listed under HYPERLINK "/rais/research/editApplication?appVersionId=2462" \l "q14-row" section A.3Research Team Members. Name:  FORMTEXT       Department/Faculty:  FORMTEXT       Email:  FORMTEXT       Phone:  FORMTEXT       Position:  FORMCHECKBOX  Faculty  FORMCHECKBOX  Undergraduate  FORMCHECKBOX  Ph.D. Student  FORMCHECKBOX Staff  FORMCHECKBOX  Masters Student  FORMCHECKBOX  Post-Doctoral  FORMCHECKBOX  Adjunct or Sessional Faculty (Appointment start and end dates):_  FORMTEXT      ____________________ Graduate secretary email (if the principal applicant is graduate student, please provide graduate secretary's email. Leave blank otherwise):  FORMTEXT       Is the principal applicant conducting this research for their academic degree at UVic Yes  FORMCHECKBOX  No  FORMCHECKBOX  3. Research team members: Individuals and organizations involved in conducting your research. This includes co-principal investigators, additional principal applicants, co-investigators, other UVic students, assistants (paid or unpaid), community organizations, and clients. Team members listed will have "no access" to application as a default. You cannot assign access to team members without Netlink ID. If they need a Netlink ID go to the HYPERLINK "https://apex.uvic.ca/aims" \t "_blank" Affiliate Identity Management Systemand click on the 'Sponsor' tab to start the process. Once you get the Netlink ID you have to re-enter their name and give access permission to the application. List all current research team members (including any UVic Graduate students or research assistants who will use the received data or biological materials to fulfill UVic thesis, dissertation, or academic requirements) and assign level of access to the application. You do not need to add the PI or PA to this table. Inclusion here satisfies only UVic institutional requirements. NameRole in Research ProjectInstitutional AffiliationEmail or Phone FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT        B. Project Information 1. Project title:  FORMTEXT       2. Anticipated duration of the project Anticipated start date for recruitment/data collection:  FORMTEXT       The approximate start date to begin recruitment and data collection for your project should take into account the time it will take to complete and submit this application form and the period of four to six weeks required for ethical review. It is a violation of University of Victoria policy to begin recruitment and data collection before receiving HREB ethics approval. Anticipated end date for your research project:  FORMTEXT       An approximate end date for recruitment and data collection. 3. Is this application linked to one that has been recently submitted to the UVic Human Research Ethics Board?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Provide further information about the linked application(s). 4. Geographic location(s) of the study:  FORMTEXT       5. Keywords to categorize your research:  FORMTEXT       C. Project Funding 1. Have you and/or research team members (their names must be listed under section A.3. Research team) applied for or been awarded funding for this project?  FORMCHECKBOX  Yes  FORMCHECKBOX  No This information is used to permit the release of funds and to ensure proper reporting of research ethics approval to funding agencies. Please ensure the information is this table is corrected. a. If yes, please complete the following: Funding SourceInstitution holding funding (Inlcude RASF #)Exact title used in funding applicationAccount holderFunding statusComments FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      2. Will this project receive funding from the US National Institutes of Health (NIH)?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, provide further information:  FORMTEXT       3. If you are a faculty member and have indicated above that you have applied for funding, have you submitted a Research Application Summary Form to the Grants or Contracts unit in the Office of Research Services? (you must submit a research application summary form to the grants or contracts office every time you apply for funding. Provide explanation if you have not done so.)  FORMCHECKBOX  Yes  FORMCHECKBOX  No a. If no (for each entry), please explain why as this is a requirement of the Office of Research Services. We may not be able to process your ethics application until this has been addresses. Please contact UVic research ethics liaison.  FORMTEXT       D. Multi-Jurisdictional Research 1. Will this research involve another academic institution or health authority in BC (e.g. recruiting through their sites/departments/listservs/poster placement, etc.; involving staff, patients, health records; research team members)? TheHYPERLINK "/research-services/_assets/docs/hre-harmonized-checklist.pdf" \t "_blank"checklistmay be useful, if unsure. Research Ethics BC harmonized review (a single coordinated review with the other institution(s) listed) applies if A) you will be conducting research under the auspices of any of the institutions listed inHYPERLINK "https://healthresearchbc.ca/research-ethics-bc/info-and-resources/information-for-researchers/" \t "_blank"REBCwebsite (involving staff, patients, health records, sites and/or recruitment through their sites, including recruitment via poster placement), and/or B) when members of your research team consist of faculty, staff and students from any of the REBC institution(s).  FORMCHECKBOX  Yes  FORMCHECKBOX  No If Yes: a. check all the BCEHI REBs involved in this research:  FORMCHECKBOX  University of Victoria  FORMCHECKBOX  Simon Fraser University  FORMCHECKBOX  University of Northern British Columbia  FORMCHECKBOX  University of British Columbia - Behavioural (BREB)  FORMCHECKBOX  Island Health  FORMCHECKBOX  University of British Columbia Clinical (CREB)  FORMCHECKBOX  Northern Health  FORMCHECKBOX  Interior Health  FORMCHECKBOX  Providence Health Care  FORMCHECKBOX  Fraser Health  FORMCHECKBOX  BC Cancer Agency  FORMCHECKBOX  Children and Womens Hospital  FORMCHECKBOX  Vancouver Coastal Health  FORMCHECKBOX  First Nations Health Authority  FORMCHECKBOX  Langara College  FORMCHECKBOX  British Columbia Institute of Technology  FORMCHECKBOX  University of British Columbia Okanagan  FORMCHECKBOX  Thompson Rivers University  FORMCHECKBOX  Camosun College  FORMCHECKBOX  Fraser Valley University  FORMCHECKBOX  Emily Carr University  FORMCHECKBOX  Kwantlen Polytechnic University  FORMCHECKBOX  Vancouver Island University  FORMCHECKBOX  Vancouver Community College  FORMCHECKBOX  Royal Roads University  FORMCHECKBOX  Douglas College  FORMCHECKBOX  Capilano University 2. Does the proposed research require Research Ethics Board (REB) approval from outside BC?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If 'Yes': a. list the other research ethics board(s) from which you or your research team members have sought approval or will seek approval (Attach proof of having applied to other research ethics board(s). Please forward approvals upon receiving them. Be assured that UVic ethics approval may be granted prior to receipt of other research ethics board approvals.)  FORMTEXT       3. If this is a multi-jurisdictional research, please indicate your role in the research project (Check all that apply). If you answered "Yes" to question D.1 please STOP completing this form and contact HRE office ethics@uvic.ca, 250-472-4321 or 250-472-4545 as soon as possible.  FORMCHECKBOX  Recruiting participants  FORMCHECKBOX  Collecting data  FORMCHECKBOX  Analyzing data (with or without identifiers) collected by you and/or UVic research team members  FORMCHECKBOX  Analyzing data that contains identifiers: Data to be collected by non-UVic research team members as outlined in this application.  FORMCHECKBOX  Analyzing data that does not contain identifiers: Data to be collected by non-UVic research team members as outlined in this application.  FORMCHECKBOX  Dissemination of result via publications, reports, conferences, internet, etc.  FORMCHECKBOX  Other (explain):  FORMTEXT       4. Additionall information  FORMTEXT       E. Other Approvals and Consultations 1. If additional request(s) for permission, approval are required please complete the section below (check all that applies). Please check all that apply:  FORMCHECKBOX  School District, Superintendent, Principal, Teacher. Please list the school districts or schools:  FORMCHECKBOX  Health Authorities outside BC involving staff, patients, health records, sites and/or recruitment through their sites (including recruitment via poster placement)  FORMCHECKBOX  Other regional government authority, please explain:  FORMCHECKBOX  Community Group (e.g., formal organization, informal collective), please explain:  FORMCHECKBOX  Other Research Ethics Board (REB) Approval, please explain:  FORMCHECKBOX  UVic Biosafety Committee Approval. Attach your Biosafety Approval, or your correspondence with the  HYPERLINK "http://ohs.uvic.ca/research_safety/registration.php" Biosafety Committee, to this application. Note that Research Ethics Approval is contingent on Biosafety Approval.  FORMCHECKBOX  Other Approval, please explain:  FORMTEXT       Comments:  FORMTEXT       Please upload proof of having made request(s) for permission or any permission/approval documents that you received. Please forward approvals upon receiving them. Be assured that ethics approval may be granted prior to receipt of external approvals. 2. Is this study a clinical trial or investigational test requiring Health Canada Regulatory approval? For more information see theHYPERLINK "https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/applications-submissions/guidance-documents.html" \t "_blank"Health Canadas guidance document on regulator approval and registration. For information on investigational devices seeHYPERLINK "https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-devices/application-information/guidance-documents/investigational-testing-authorizations-guidance/guidance-document.html" \t "_blank"Health Canadas guidance document on applications for medical device investigational testing authorizations. The sponsor is an individual, company, institution, or organization that takes responsibility for the initiation, management, and/or financing of a clinical trial. For unfunded/investigator initiated studies, the sponsor could be the principal/qualified investigator. The sponsor is usually responsible for applying for regulatory approval with the Health Protection and Food Branch of Health Canada. Refer to Section 5 of theHYPERLINK "https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/applications-submissions/guidance-documents/international-conference-harmonisation/efficacy/good-clinical-practice-consolidated-guideline-topic.html" \t "_blank"Good Clinical Practice guidelinesfor a full description of the duties and responsibilities of the sponsor. F. Scholarly Review 1. What type of scholarly review has this research project undergone?  FORMCHECKBOX  External Peer Review (e.g., granting agency)  FORMCHECKBOX  Supervisory Committee or Supervisorrequired for all student research projects  FORMCHECKBOX  None  FORMCHECKBOX  Other, please explain:  FORMTEXT       G. Researcher(s) Qualifications 1. In light of your research methods, the nature of the research, and the characteristics of the participants, what training, qualifications, or personal experiences do you and/or your research team have (e.g., research methods course, language proficiency, committee expertise, training on the equipment to be used)?  FORMTEXT      2. Tri-Council Policy Statement - HYPERLINK "https://ethics.gc.ca/eng/education_tutorial-didacticiel.html" \t "_blank" TCPS2 CORE Tutorialrequirements All UVic graduate students conducting research with human participants for their UVic project, thesis or dissertation are required to complete the Course on Research Ethics (CORE Tutorial) and provide evidence of ethics training by uploading a CORE completion certificate under this section. List all current UVic graduate students (also listed under A.2 and A.3) involved in this research project for their UVic project thesis or dissertation, and upload their Course on Research Ethics (CORE) tutorial certificate(s), if available. This CORE certification is required as of September 1, 2020 for new applications - see the HYPERLINK "/research/conduct/home/regapproval/humanethics/index.php" \t "_blank" human research ethicsweb page for more information. NameEmailRole in the projectCORE Tutorial completion date H. Research Involving Indigenous Peoples of Canada (Including First Nations, Inuit and Mtis) The TCPS 2 (Chapter 9) is designed to serve as a framework for the ethical conduct of research involving Aboriginal (including First Nations, Inuit and Mtis) or Indigenous peoples, regardless of where they reside or whether or not their names appear on an official register. Its purpose is to ensure, to the extent possible, that research involving Indigenous peoples is premised on respectful relationships and encourages collaboration and engagement between researchers and participants. This Policy acknowledges the role of the community in shaping the conduct of research that affects First Nations, Inuit, and Mtis peoples. The nature and extent of community engagement should be determined through discussion with, and under the advisement of, the relevant community, taking into account relevant characteristics and protocols and the nature of the research. The University of Victoria Indigenous Plan recognizes that research with Indigenous communities or involving Indigenous peoples must be conducted in a respectful and culturally appropriate manner, following protocols regarding entering community sites, engaging with communities, Elders and Knowledge Keepers, acknowledging cultural knowledge and cultural property, and disseminating research findings. (/vpacademic/assets/docs/indigenousacademicplan/IndigenousPlan_Final.pdf) Conditions of the Research 1a. Will you be conducting research that is situated on any of the following kinds of lands or waterways: First Nation reserves, Indigenous settlements, Indigenous lands under self-government agreements, territories with Indigenous land claims agreements, or other lands designated by Federal, Provincial, or local governments as Indigenous territory?  FORMCHECKBOX  No  FORMCHECKBOX  Yes, provide details: 1b. Do any of the criteria for participation include belonging to an Indigenous nation, community, group of communities, or organization, including urban Indigenous populations?  FORMCHECKBOX  No  FORMCHECKBOX  Yes, provide details: 1c. Does the research seek input from participants regarding Indigenous cultural heritage, cultural practices, artifacts, Indigenous or traditional knowledges, or distinct characteristics of Indigenous experience or reality?  FORMCHECKBOX  Yes  FORMCHECKBOX  No 1d. Will Indigenous identity or membership in an Indigenous community or group (e.g. Mtis Nation) be used as a variable for the purposes of analysis?  FORMCHECKBOX  Yes  FORMCHECKBOX  No 1e. Will the results of the research make specific reference to Indigenous communities, homelands and/or waterways, peoples, languages, histories or cultures?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Indigenous Engagement 2a. Processes and protocols for engagement differ across communities, organizations, committees, and groups, as well as across different research contexts. Describe the process that you have followed with respect to Indigenous engagement. Include any documentation of collaboration (e.g. formal research agreement, letter of approval, email communications, advisory committee, mentorship, etc.) and the role or position of those consulted (e.g. Elder, Knowledge Holder, governing body, Chief, etc.), including their names, if appropriate.  FORMTEXT       2b. Explain how Indigenous community members will be meaningfully involved throughout the research process, from research design to knowledge sharing. Outline the plan, as developed with the community, for the outcomes of the research, including research data ownership, sharing, storage, and governance.  FORMTEXT       2c. If you have answered  yes to any of the questions in H.1 but have not yet engaged with the community, committee, organization, or group, please explain why not and outline how you plan to conduct a study that respects Indigenous communities and participants in the absence of prior engagement.  FORMTEXT       Indigenous Engagement  FORMTEXT       I. International Research Will this study be conducted in a country other than Canada?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, describe how the laws, customs and regulations of the host country will be addressed (consider research Visas, local Institutional Research Ethics Board requirements, etc.):  FORMTEXT      J. Description of Research Project Briefly describe in non-technical language a. The research objective(s) and question(s)  FORMTEXT      b. The importance and contributions of the research  FORMTEXT      c. If applicable, provide background information or details that will enable the HREB to understand the context of the study when reviewing the application.  FORMTEXT      K. Recruitment Participant details Provide details of your participants a. Briefly describe the target population(s) for recruitment. Ensure that all participant groups are identified (e.g. group 1 - teacher, group 2 - administrators, group 3 - parents).  FORMTEXT      b. Why is each population or group of interest?  FORMTEXT      c. What are the salient characteristics of the participants for your study? (e.g., age, gender, race, ethnicity, class, position, etc.)? List all inclusion and exclusion criteria you are using.  FORMTEXT      d. What is the desired number of participants for each group?  FORMTEXT       2. Recruitment and process Provide details of your recruitment processList all source(s) for information used to contact potential participants (e.g., personal contacts, listserves, publicly available contact information, etc.). Clarify which sources will be used for which participant groups:  FORMTEXT       List all methods of recruitment (e.g., in-person, by telephone, letter, snowball sampling, word-of-mouth, advertisement, etc.) If you will be using  snowball sampling, clarify how this will proceed (i.e., will participants be asked to pass on your study information to other potential participants?). Clarify which methods will be used for which participant groups.  FORMTEXT       If you will be using personal and/or private contact information to contact potential participants (as stated above), have the potential participants given permission for this, or will you use a neutral third party to assist you with recruitment? Note that this is not a concern when public and/or business contact information is used.  FORMTEXT       Who will recruit/contact participants (e.g., researcher, assistant, third party, etc.) Clarify this for each participant group.  FORMTEXT       List and explain any relationship between the members of the research team (including third party recruiters or sponsors/clients of the research) and the participant(s) (e.g., acquaintances, colleagues). Complete item 7 if there is potential for a power relationship or a perceived power relationship (e.g., instructor-student, manager-employee, etc.). If you have a close relationship with potential participants (e.g., family member, friend, close colleague, etc.) clarify here the safeguards that you will put in place to mitigate any potential pressure to participate.  FORMTEXT       In chronological order (if possible) describe the steps in the recruitment process. (Include how you will screen potential participants where applicable). Consider where in the process permission of other bodies may be required.  FORMTEXT       3. Power Relationships (Dual-Role and Power-Over) If you are completing this section, please refer to the: Guidelines For Ethics in Dual-Role Research for Teachers and Other Practitioners and the TCPS 2, Article 3.1 and Article 7.4. Are you or any of your co-researchers in any way in a power relationship, including dual-roles, that could influence the voluntariness of a participants consent? Could you or any of your co-researchers potentially be perceived to be in a power relationship by potential participants? Examples of power relationships include teachers-students, therapists-clients, supervisors-employees and possibly researcher-relative or researcher-close friend where elements of trust or dependency could result in undue influence.  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX Varies If yes or varies, describe below: The nature of the relationship:  FORMTEXT       Why it is necessary to conduct research with participants over whom you have a power relationship:  FORMTEXT       What safeguards (steps) will be taken to ensure voluntariness and minimize undue influence, coercion or potential harm:  FORMTEXT       How will the power or dual-role relationship and associated safeguards be explained to potential participants:  FORMTEXT        FORMTEXT       Recruitment Materials Checklist: Upload all the documents that you think may be relevant to this section (check those that are uploaded):  FORMCHECKBOX  Script(s) in-person, telephone, 3rd party, e-mail, etc.  FORMCHECKBOX  Invitation to participate (e.g., Psychology Research Participation System Posting)  FORMCHECKBOX  Advertisement, poster, flyer  FORMCHECKBOX  None; please explain why (e.g., consent form used as invitation/recruitment guide)  FORMTEXT       L. Data Collection Methods Data Collection Use the following sections in ways best suited to explain your project. If you have more than one participant group, be sure to explain which participant group(s) will be involved in which activity/activities or method(s). a. Which of the following methods will be used to collect data? Check all that apply.  FORMCHECKBOX  Interviewing participants:  FORMCHECKBOX  in-person  FORMCHECKBOX  by telephone  FORMCHECKBOX  using web-based technology (explain):  FORMCHECKBOX  Conducting group interviews or discussions (including focus groups) Explain and provide the name of the web-based technology or technologies (e.g., SurveyMonkey), and see the U.S. Freedom Act advisory below. If using a web program (online surveys, video conferencing etc.) with a server located in the United States (e.g. SurveyMonkey), or if there are other reasons that the data will be stored in the US (e.g. use of US-based cloud technology, sharing data with US colleagues, etc.),you must inform participants that their responses may be accessed via the U.S. Freedom Act. Please add the following to the consent form(s): "Please be advised that this research study includes data storage in U.S.A. As such, there is a possibility that information about you that is gathered for this research study may be accessed without your knowledge or consent by the U.S. government, in compliance with the U.S. Freedom Act." FORMCHECKBOX  Attach draft interview questions FORMCHECKBOX  Administering a questionnaire or survey:  FORMCHECKBOX  In person  FORMCHECKBOX  by telephone  FORMCHECKBOX  mail back  FORMCHECKBOX  email  FORMCHECKBOX  web-based* (see below)  FORMCHECKBOX  Other, describe: *If using a web program with a server located in the United States (e.g., SurveyMonkey), or if there are other reasons that the data will be stored in the US (e.g., use of US-based cloud technology, sharing data with US colleagues, etc.), you must inform participants that their responses may be accessed via the U.S. Patriot Act. Please add the following to the consent form(s): Please be advised that this research study includes data storage in the U.S.A. As such, there is a possibility that information about you that is gathered for this research study may be accessed without your knowledge or consent by the U.S. government in compliance with the U.S. Patriot Act.  FORMCHECKBOX  Attach questionnaire or survey:  FORMCHECKBOX  standardized (one with established reliability and validity)  FORMCHECKBOX  non-standardized (one that is un-tested, adapted or open-ended) FORMCHECKBOX  Administering a computerized task (describe in L.1b or attach details)  FORMCHECKBOX  Observing participants In 8b, describe who and what will be observed. Include where observations will take place. If applicable, forward an observational data collection sheet for review. FORMCHECKBOX  Recording of participants and data using:  FORMCHECKBOX  audio  FORMCHECKBOX  video  FORMCHECKBOX  photos or slides  FORMCHECKBOX  note taking  FORMCHECKBOX  flipcharts  FORMCHECKBOX  data collection sheet (attach)  FORMCHECKBOX  other:  FORMCHECKBOX  Images used for analysis  FORMCHECKBOX  Images used in disseminating results (include release to use participant images in consent materials) FORMCHECKBOX  Using human samples (e.g., saliva, urine, blood, hair) Attach your Biosafety Approval, or your correspondence with the  HYPERLINK "http://ohs.uvic.ca/research_safety/registration.php" Biosafety Committee, to this application. Note that Research Ethics Approval is contingent on Biosafety Approval. FORMCHECKBOX  Using specialized equipment/machines (e.g., ultrasound, EEG, prototypes etc.) or other. (e.g., testing instruments that are not surveys or questionnaires). Please specify:  FORMTEXT       FORMCHECKBOX  Using other testing equipment not captured under other categories. Please specify:  FORMCHECKBOX  Collecting materials supplied by, or produced by, the participants (e.g., artifacts, paintings, drawings, photos, slides, art, journals, writings, etc.) Please specify:  FORMTEXT       FORMCHECKBOX  Analyzing secondary data or secondary use of data (Refers to information/data that was originally gathered for a purpose other than the proposed research and is now being considered for use in research (e.g., patient or school records, personal writings, lesson plans, etc.).  FORMCHECKBOX  Secondary data involving anonymized information (Information/data is stripped of identifiers by another researcher or institution before being shared with the applicant).  FORMCHECKBOX  Secondary data with identifying information (Data contains names and other information that can be linked to individuals,( e.g., student report cards, employment records, meeting minutes, personal writings). In item 8b describe the source of the data, who the appropriate data steward is, and explain whether (and how) consent was or will be obtained from the individuals for use of their data. FORMCHECKBOX  Other: Please specify:  FORMTEXT       b. Provide a sequential description of the procedures/methods to be used in your research study. Be sure to provide details for all methods checked in section L.1a. Clarify which procedures/methods will be used for each participant group. Indicate which methods, if any, will be conducted in a group setting. List all of the research instruments and interview/focus group questions, and append copies (if possible) or detailed descriptions of all instruments. If not yet finalized, provide drafts or sample items/questions. If using a web program (online surveys, video conferencing etc.) with a server located in the United States (e.g. SurveyMonkey), or if there are other reasons that the data will be stored in the US (e.g. use of US-based cloud technology, sharing data with US colleagues, etc.),you must inform participants that their responses may be accessed via the U.S. Freedom Act. Please add the following to the consent form(s): "Please be advised that this research study includes data storage in U.S.A. As such, there is a possibility that information about you that is gathered for this research study may be accessed without your knowledge or consent by the U.S. government, in compliance with the U.S. Freedom Act."  FORMTEXT      c. Where will participation take place for each data collection method/procedure? Provide specific location, (e.g., UVic classroom, private residence, participant s workplace). Clarify the locations for each participant group and/or each data collection method.  FORMTEXT      d. For each method, and in total, how much time will be required of participants? Clarify this for each participant group, each data collection method, and any other research related activities.  FORMTEXT       e. Will participation take place during participants office/work hours or instructional time?  FORMCHECKBOX  No  FORMCHECKBOX  Yes. Indicate whether permission is required (e.g., from workplace supervisor, school principal, etc.) and how this will be obtained:  FORMTEXT       Data Collection Methods Checklist: Make sure that you have uploaded all the documents relevant to this section. Add any other documents that you think may be relevant to this section.  FORMCHECKBOX  Standardized Instrument(s)  FORMCHECKBOX  Survey(s), Questionnaire(s)  FORMCHECKBOX  Interview and/or Focus Group Questions  FORMCHECKBOX  Observation Protocols  FORMCHECKBOX  Other: M. Possible Benefits, Inconveniences, and Risks of Harm to Participants Benefits Identify any potential or known benefits associated with participation and explain below. Keep in mind that the anticipated benefits should outweigh any potential risks.  FORMCHECKBOX  To the participant  FORMCHECKBOX  To society  FORMCHECKBOX  To the state of knowledge  FORMTEXT      Inconveniences Identify and describe any known or potential inconveniences to participants: Consider all potential inconveniences, including total time devoted to the research. Level of Risk The TCPS 2 definition of  minimal risk research is as follows: Research in which the probability and magnitude of possible harms implied by participation in the research is no greater than those encountered by the participant in those aspects of their everyday life that relate to the research. Based on this definition, do you believe your research qualifies as minimal risk research?  FORMCHECKBOX  Yes it is minimal risk.  FORMCHECKBOX  No, it is not minimal risk. Explain your answer with reference to the risks of the study and the vulnerability of the participants:  FORMTEXT       Estimate of Risks of Harm Consider the inherent foreseeable risks associated with your research protocol and complete the table below by putting an X in the appropriate boxes. Be sure to take into account the vulnerability of your target population(s) if applicable: Potential Risks of HarmVery unlikelyPossiblyLikelyi) Emotional or psychological discomfort, such as feeling demeaned or embarrassed due to the research FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX ii) Fatigue or stress FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX iii) Social risks, such as stigmatization, loss of status, privacy and/or reputation FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX iv) Physical risks such as falls FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX v) Economic risk (e.g., job security, salary loss, etc.)  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX vi) Risk of incidental findings (See Article 3.4 of the TCPS 2 for more information) FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX vii) Other risks:  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Possible Risks of Harm If you indicated in Item 12 (i) to (vii) that any risks of harm are possible or likely, please explain below: 13a. What are the risks? (i.e., elaborate on risks you have identified above)  FORMTEXT       13b. What will you do to try to minimize, mitigate, or prevent the risks?  FORMTEXT      13c. How will you respond if the harm occurs? (i.e., what is your plan?)  FORMTEXT      13d. If you have indicated that there is a risk of Incidental Findings (vi) please outline your proposed protocol for information and/or action.  FORMTEXT      13e. If one or more of your participant groups could be considered vulnerable please describe any specific considerations you have built into the protocol to address this.  FORMTEXT       Risk to Researcher(s) 14a. Does this research study pose any risks to the researchers, assistants and data collectors?  FORMTEXT      14b. If there are any risks, explain the nature of the risks, how they will be minimized, and how you will respond if they occur.  FORMTEXT      Deception Will participants be fully informed of everything that will be required of them prior to the start of the research session?  FORMCHECKBOX Yes  FORMCHECKBOX  No (If no, complete the Request to Use Deception form on the ORS website) N. Incentives, Reimbursement and Compensation 1. Is there any incentive, monetary or otherwise, being offered for participation in the research (e.g., gifts, honorarium, course credits, etc.) Visit theHYPERLINK "/vpfo/financial-services/resources/research-participant-payments-and-alternatives.php" \t "_blank"Research accounting pagefor more information on research participant payments and alternatives that may affect the universitys and the participants tax reporting requirements.  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, explain the nature of the incentive(s) and why you consider it necessary. Also consider whether the amount or nature of the incentive could be considered a form of undue inducement or affect the voluntariness of consent. Clarify which participant groups will be provided with which incentives.  FORMTEXT       2. Is there any reimbursement or compensation for participating in the research (e.g., for transportation, parking, childcare, etc.) Visit theHYPERLINK "https://www.uvic.ca/vpfo/financial-services/resources/research-participant-payments-and-alternatives.php" \t "_blank"Research accounting pagefor more information on research participant payments and alternatives that may affect the universitys and the participants tax reporting requirements.  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, explain the nature of reimbursement or compensation and why you consider it necessary. Also consider whether the amount of reimbursement or compensation could be considered a form of undue inducement or affect the voluntariness of consent. 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Consult Article 3.2 of the TCPS 2 and Appendix V of the Guidelines for further information. Participants Capacity (Competence) to Provide Free and Informed Consent Capacity refers to the ability of prospective or actual participants to understand relevant information presented about a research project, and to appreciate the potential consequences of their decision to participate or not participate. See the TCPS 2, Chapter 3, section C, for further information. Identify your potential participants: (Check all that apply.) CompetentNon-Competent FORMCHECKBOX  Competent adults  FORMCHECKBOX  A protected or vulnerable population (e.g., inmates, patients) FORMCHECKBOX  Non-competent adults:  FORMCHECKBOX  Consent of family/authorized representative will be obtained  FORMCHECKBOX  Assent of the participant will be obtained (note that assent of the participant is always required) FORMCHECKBOX  Competent youth aged 13 to 18:  FORMCHECKBOX  Consent of youth will be obtained and parental/guardian consent is required, due to institutional requirements (such as school districts) or due to the nature of the research (e.g., risks, etc.)  FORMCHECKBOX  Consent of youth will be obtained, parents/guardians will be informed  FORMCHECKBOX  Consent of youth will be obtained, parents/guardians will NOT be informed  FORMCHECKBOX  Other, explain:  FORMCHECKBOX  Non-competent youth:  FORMCHECKBOX  Consent of parent/guardian  FORMCHECKBOX  Assent of the youth will be obtained (note that assent of the participant is always required) FORMCHECKBOX  Competent children under 13 (who are able to provide fully informed consent):  FORMCHECKBOX  Consent of child will be obtained and consent of parent/guardian will be obtained  FORMCHECKBOX  Other, explain:  FORMCHECKBOX  Non-competent children (young children and/or children with limited abilities to provide fully informed consent):  FORMCHECKBOX  Consent of parent/guardian  FORMCHECKBOX  Assent of the child will be obtained (note that assent of the participant is always required) Means of Obtaining and Documenting Consent and/or Assent: Check all that apply, consider all of your participant groups, attach copies of relevant materials, complete item 19:  FORMCHECKBOX  Signed consent (Attach consent form(s) - see template available )  FORMCHECKBOX  Verbal consent (Attach verbal consent script(s) - see template available.) Explain in 19 why written consent is not appropriate and how verbal consent will be documented.  FORMCHECKBOX  Letter of Information for Implied consent (e.g., anonymous, mail back or web-based survey. Attach information letter, see template)  FORMCHECKBOX  Signed or Verbal assent for non-competent participants (Attach assent form(s), or verbal assent script(s)). Explain how verbal assent will be documented in 19.  FORMCHECKBOX  Other means. Explain in 19 and provide justification.  FORMCHECKBOX  Consent will not be obtained. See TCPS 2 Articles 3.5 and 3.7. Explain in 19.  FORMCHECKBOX  Signed consent from the parents/guardians for youth/child participants (Attach consent form(s)). Explain how parents/guardians will provide informed consent for child/youth participants in 19.  FORMCHECKBOX  Information letters for the parents/guardians of youth/child participants (Attach information letter(s)). If consent will not be obtained from parents/guardians and the parents/guardians will not be informed, explain why not in 19. Informed Consent Describe the exact steps (chronological order) that you will follow in the process of explaining, obtaining, and documenting informed consent. Ensure that consent procedures for all participant groups are identified (e.g., group 1 - teachers, group 2 parents, group 3 students). Be sure to indicate when participants will first be provided with the consent materials (e.g., prior to first meeting with the researcher?). If consent will not be obtained, explain why not with reference to the TCPS 2 Articles 3.5 and 3.7.  FORMTEXT       Ongoing Consent Article 3.3 of the TCPS 2 states that consent shall be maintained throughout the research project. Complete this section if the research involves interacting with participants over multiple occasions (including review of transcripts, etc.), has multiple data collection activities, and/ or occurs over an extended period of time. Will your research occur over multiple occasions or an extended period of time (including review of transcripts)?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, describe how you will obtain and document ongoing consent. If consent procedures differ for each group or activity, please clarify each group or activity that you are referring to.  FORMTEXT      Participant s Right to Withdraw Article 3.1 of the TCPS2 states that participants have the right to withdraw at any time and can withdraw their data and human biological materials. Describe what participants will be told about their right to withdraw from the research at any time (i.e., who to contact and how). If compensation is involved, explain what participants will be told about compensation if they withdraw. If you have different participant groups and/or different data collection methods, clarify the different procedures for withdrawing as necessary.  FORMTEXT      What will happen to a person s data if s/he withdraws part way through the study or after the data have been collected/submitted? If applicable, include information about visual data such as photos or videos. If you have different participant groups and/or different data collection methods, clarify the different procedures for withdrawing as necessary. Ensure this information is included in the consent documents.  FORMCHECKBOX  Participant will be asked if he/she agrees to the use of his/her data. Describe how this agreement will be documented:  FORMTEXT        FORMCHECKBOX  It will not be used in the analysis and will be destroyed.  FORMCHECKBOX  It is logistically impossible to remove individual participant data (e.g., anonymously submitted data).  FORMCHECKBOX  When linked to group data (e.g., focus group discussions), it will be used in summarized form with no identifying information. P. Anonymity and Confidentiality Anonymity Anonymity means that no one, including the principal investigator, is able to associate responses or other data with individual participants. a. Will the participants be anonymous in the data gathering phase of research?  FORMCHECKBOX  Yes  FORMCHECKBOX  No b. Will the participants be anonymous in the dissemination of results (be sure to consider use of video, photos)?  FORMCHECKBOX  Yes  FORMCHECKBOX  Maybe. Explain below.  FORMCHECKBOX  No. If anonymity will not be protected and you plan to identify all participants with their data, provide the rationale below. Confidentiality Confidentiality means the protection of the persons identity (anonymity) and the protection, access, control and security of his or her data and personal information during the recruitment, data collection, reporting of findings, dissemination of data (if relevant) and after the study is completed (e.g., storage). The ethical duty of confidentiality refers to the obligation of an individual or organization to safeguard entrusted information. The ethical duty of confidentiality includes obligations to protect information from unauthorized access, use, disclosure, modification, loss or theft. a. Are there any limits to protecting the confidentiality of participants?  FORMCHECKBOX  No, confidentiality of participants and their data will be completely protected  FORMCHECKBOX  Yes, there are some limits to the researchers ability to protect the confidentiality of participants (Check relevant boxes below.)  FORMCHECKBOX  Limits due to the nature of group activities (e.g., focus groups): The researcher cannot guarantee confidentiality  FORMCHECKBOX  Limits due to context: The nature or size of the sample from which participants are drawn makes it possible to identify individual participants (e.g., school principals in a small town, position within an organization)  FORMCHECKBOX  Limits due to selection: The procedures for recruiting or selecting participants may compromise the confidentiality of participants (e.g., participants are identified or referred to the study by a person outside the research team)  FORMCHECKBOX  Limits due to legal requirements for reporting (e.g., legal or professional)  FORMCHECKBOX  Limits due to local legislation such as the U.S.A. Patriot Act (e.g., when there will be data storage in the United States). When using USA based data instruments and data storage systems researchers are responsible for determining if this applies.  FORMCHECKBOX  Other: b. If confidentiality will be protected, describe the procedures to be used to ensure the anonymity of participants and for preserving the confidentiality of their data (e.g., pseudonyms, changing identifying information and features, coding sheet, etc.) If you will use different procedures for different participant groups and/or different data methods be sure to clarify each procedure.  FORMTEXT      c. If there are limits to confidentiality indicated in section 24a. above, explain what the limits are and how you will address them with the participants. If there are different procedures for different participant groups and/or different data collection methods, be sure to clarify each procedure.  FORMTEXT      Q. Data management Use(s) of Data a. What use(s) will be made of all types of data collected (field notes, photos, videos, audiotapes, transcripts, etc.)?  FORMTEXT      b. Will your research data be analyzed, now or in future, by yourself for purposes other than this research project?  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Possibly If yes or possibly, indicate what purposes you plan for this data and how will you obtain consent for future data analysis from the participants (e.g., request future use in current consent form)?  FORMTEXT      c. Will your research data be analyzed, now or in future, by other persons for purposes other than explained in this application?  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Possibly e. If yes or possibly: i) Indicate whether the data will contain identifiers when it is provided to the other researchers or whether it will be fully anonymous (note that fully anonymous means that there is no identifying information, links, keys, or codes that allow the data to be re-identified).  FORMTEXT      ii) How will you obtain consent from the participants for future data analysis by other researchers? (If the data will be transferred in fully anonymous form, this request for future use can be made in the current consent form. If the data will contain identifiers or links/keys/codes for re-identification, consider requesting permission to contact the participants in the future, to obtain consent for the use of the data at that time).  FORMTEXT      Commercial Purposes a. 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*hhhAH5CJOJQJUmH nH u#hhhAHCJOJQJmH nH u#hhhAHCJOJQJmH nH uhhhAH5CJmH nH u)j *hhn5CJU^J *hhn5CJ^J#j *hhn5CJU^J&hhhAH6CJOJQJmH nH uhhhAHCJmH nH u`T 8xx$If Hdh^$ Hxx^ $ & F0xgd?kd[$$Ifl`'$$644 la< ~ ./01TUcdɷɐsɷqɐTɷɐ78j *hhhAH5CJOJQJUmH nH u8j *hhhAH5CJOJQJUmH nH uU8j+ *hhhAH5CJOJQJUmH nH u) *hhhAH5CJOJQJmH nH u#hhhAHCJOJQJmH nH u#hhhAHCJOJQJmH nH u2j *hhhAH5CJOJQJUmH nH u8j *hhhAH5CJOJQJUmH nH untations at scholarly meetings  FORMCHECKBOX  Published article, chapter or book  FORMCHECKBOX  Internet (Students: Most UVic Theses are posted on UVicSpace and can be accessed by the public)  FORMCHECKBOX  Media (e.g., newspaper, radio, TV)  FORMCHECKBOX  Directly to participants and/or groups involved. Indicate how: (e.g., report, executive summary, newsletter, information session):  FORMCHECKBOX  Other, explain:  FORMTEXT       R. Conflict of Interest a. Apart from a declared dual-role relationship (Section K, item 7), are you or any of the research team members in a perceived, actual or potential conflict of interest regarding this research project (e.g., partners in research, private interests in companies or other entities)?  FORMCHECKBOX  Yes  FORMCHECKBOX  No b. 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