Request For Ethical Approval For Individual Study /

Programme Of Research

School:
Research centre:
Group
memb
ers:
Contact Info

Email:

Tel No. Address:

Student:
If you are a student please state who your supervisor is:
Supervisor:
Title or topic area of proposed study

What are the aims and objectives of your study?

Brief review of relevant literature and rationale for study

Outline of study design and methods

What resources will you require? (e.g. questionnaires, equipment, for example video camer
specialised software; if questionnaires are to be used please give full details here).

Ethical Considerations (Please indicate how you intend to address each of the following in your study)

Confidentiality

Protection of participants

Giving advice the researcher will not be involved with giving advice to the participant

Have/Do you intend to request clearance from any other body/organisation ?

as appropriate) No

Yes/No

(please circ

If Yes please give details below.

The information supplied is, to the best of my knowledge and belief, accurate. I clearly understand my
obligations and the rights of the participants. I agree to act at all times in accordance with University of Derby
Ethical Policy for conducting research with human participants.
Date of submission..
Signature of applicant
Signature of supervisor (if appropriate)N/A

To,
The

respected members of ethics committee,

Please screen our proposal and provide ethical clearance, so that we will be
eligible to commence data collection.
Thankyou