North Central College - Naperville, IL

Human Subject: Application

Cover Sheet

Application for Research Ethics Committee Review - Human Participants Research

North Central College

Instructions: Please submit a copy of your application to the Chair of the Research Ethics Committee. Be sure to address all of the issues listed below in order, using the appropriate headings.

Title. Provide a descriptive title of your proposed research project.

Investigator(s). List the names, titles, and affiliations of all individuals directing the research. State whether external funding will be provided, and whether the research is being conducted in the context of a course.

Duration and Location of Research. Provide the projected starting and ending dates for data collection, and explain where data collection will take place. If research is being conducted off-campus, please attach documentation that the research has been approved by the off-campus facility.

Description of Research. Describe the goals of the proposed research and the methodology that will be used to fulfill those goals.

Participants. Describe how your participants will be solicited, how many participants will be needed, what restrictions (if any) there will be on your sample, etc. If participants include populations likely to be vulnerable to coercion or undue influence (such as children, prisoners, mentally disabled persons, or economically or educationally disadvantaged persons), what additional safeguards have been included in the study to protect the rights and welfare of these participants? Are the research subjects in a class? Will participants be provided with any form of compensation? If so, describe.

Confidentiality. Explain how confidentiality of participants’ personal information and/or responses will be maintained. Include a description of how data kept electronically will be kept secure.

Risks and Benefits. Provide an account of all potential risks to participants. Note how participants will be informed of these risks, and what steps will be taken to minimize and deal with these risks. If there are any anticipated benefits to participants, describe these as well.

Informed consent. Explain how informed consent will be gained from participants and documented. Attach a copy of your informed consent form and other appropriate supportive documents, including any "script" read to participants describing their rights in the study. If full informed consent is not obtained from participants, explain the rationale for not obtaining full informed consent.

Debriefing. Explain how participants will be debriefed (where appropriate).

Training of Research Assistants. If research assistants are used, how will they be trained to carry out research safely and ethically?

I have reviewed the regulations governing the NCC Research Ethics Committee and certify that my proposed research is in compliance with those regulations. I also certify that the information presented above is accurate and complete. I agree that, in the event that the conditions and/or procedures of the proposed research undergo substantial change, I am required to submit a new approval form to the Research Ethics /Committee before further research activity may proceed.

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Signature of Primary Investigator

If your research involves surveying 50 or more current or past NCC students, the Institutional Assessment and Accreditation Team requests that you notify them through their website (http://intranet.noctrl.edu/FACSTAFF/assessment/).  Institutional Assessment and Accreditation will not provide or maintain data, results or analyses from student surveys.  This will not affect the evaluation of your research by the Research Ethics Committee.  Thank you for your cooperation.