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| − | <o:Author>*Harvey J. Krahn</o:Author>
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| − |
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| − | <p class=MsoNormal align=center style='text-align:center'><span lang=EN-US><o:p> </o:p></span></p>
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| − | <h1><st1:place w:st="on"><st1:PlaceType w:st="on"><i style='mso-bidi-font-style:
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| − | normal'><span lang=EN-US style='font-size:12.0pt;mso-bidi-font-size:10.0pt'>UNIVERSITY</span></i></st1:PlaceType><i
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| − | style='mso-bidi-font-style:normal'><span lang=EN-US style='font-size:12.0pt;
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| − | mso-bidi-font-size:10.0pt'> OF <st1:PlaceName w:st="on">ALBERTA</st1:PlaceName></span></i></st1:place><i
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| − | style='mso-bidi-font-style:normal'><span lang=EN-US style='font-size:12.0pt;
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| − | mso-bidi-font-size:10.0pt'><o:p></o:p></span></i></h1>
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| − |
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| − | <p class=MsoNormal align=center style='text-align:center'><b style='mso-bidi-font-weight:
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| − | normal'><i style='mso-bidi-font-style:normal'><span lang=EN-US
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| − | style='font-size:12.0pt;mso-bidi-font-size:10.0pt'>FACULTY OF ARTS, SCIENCE
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| − |
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| − | & LAW RESEARCH ETHICS BOARD</span></i></b><b style='mso-bidi-font-weight:
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| − | normal'><span lang=EN-US style='font-size:12.0pt;mso-bidi-font-size:10.0pt'> <o:p></o:p></span></b></p>
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| − |
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| − | normal'><span lang=EN-US style='font-size:14.0pt;mso-bidi-font-size:10.0pt'><o:p> </o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal align=center style='text-align:center'><b style='mso-bidi-font-weight:
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| − | normal'><i style='mso-bidi-font-style:normal'><span lang=EN-US
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| − | style='font-size:14.0pt;mso-bidi-font-size:10.0pt'>APPLICATION TO CONDUCT
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| − | RESEARCH <o:p></o:p></span></i></b></p>
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| − |
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| − | <p class=MsoNormal align=center style='text-align:center'><b style='mso-bidi-font-weight:
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| − | normal'><i style='mso-bidi-font-style:normal'><span lang=EN-US
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| − | style='font-size:14.0pt;mso-bidi-font-size:10.0pt'>INVOLVING HUMAN PARTICIPANTS<o:p></o:p></span></i></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><o:p> </o:p></span></b></p>
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><o:p> </o:p></span></b></p>
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'>Principal Investigator(s):<span
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| − | style='mso-tab-count:1'> </span>Name(s):<span style='mso-spacerun:yes'>
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| − | </span><u><span style='mso-tab-count:7'> </span><o:p></o:p></u></span></b></p>
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><o:p> </o:p></span></b></p>
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><span style='mso-tab-count:
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| − | 4'> </span>Department/Faculty:<span
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| − | style='mso-tab-count:1'> </span><u><span style='mso-tab-count:5'> </span></u><o:p></o:p></span></b></p>
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><o:p> </o:p></span></b></p>
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><span style='mso-tab-count:
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| − | 4'> </span>Campus Address:<span
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| − | style='mso-spacerun:yes'> </span><u><span style='mso-tab-count:6'> </span></u><span
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| − | style='mso-tab-count:2'> </span><o:p></o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><span style='mso-tab-count:
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| − | 4'> </span>Campus Phone number:<span
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| − | style='mso-tab-count:1'> </span><u><span style='mso-tab-count:4'> </span></u><span
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| − | style='mso-tab-count:1'> </span><o:p></o:p></span></b></p>
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| − |
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><span style='mso-tab-count:
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| − | 4'> </span>E-mail address:<span
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| − | style='mso-tab-count:1'> </span><u><span style='mso-tab-count:5'> </span></u><o:p></o:p></span></b></p>
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| − |
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><o:p> </o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'>(<i style='mso-bidi-font-style:
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| − | normal'>If student</i>)<span style='mso-tab-count:3'> </span>Name
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| − | / Department<span style='mso-spacerun:yes'> </span><o:p></o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal style='margin-left:1.5in;text-indent:.5in'><b
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| − | style='mso-bidi-font-weight:normal'><span lang=EN-US style='font-size:11.0pt;
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| − | mso-bidi-font-size:10.0pt'>of Faculty Supervisor / Sponsor <u><span
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| − | style='mso-tab-count:4'> </span></u><o:p></o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><o:p> </o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><span style='mso-tab-count:
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| − | 4'> </span>Supervisor's E-mail
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| − | address: <span style='mso-tab-count:1'> </span><u><span
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| − | style='mso-tab-count:4'> </span></u><o:p></o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><o:p> </o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><span style='mso-tab-count:
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| − | 4'> </span>Supervisor's Campus
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| − | Phone number:<span style='mso-tab-count:1'> </span><u><span
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| − | style='mso-tab-count:3'> </span></u><o:p></o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><o:p> </o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><o:p> </o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'>Project Title:<span
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| − | style='mso-tab-count:1'> </span><u><span style='mso-tab-count:10'> </span></u><o:p></o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><o:p> </o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'>Funding Source(s): <u><span
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| − | style='mso-tab-count:1'> </span><span style='mso-tab-count:9'> </span></u><o:p></o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><o:p> </o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><o:p> </o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><o:p> </o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><u><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'>Summary of Project /
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| − | Research Design</span></u></b><b style='mso-bidi-font-weight:normal'><span
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| − | lang=EN-US style='font-size:11.0pt;mso-bidi-font-size:10.0pt'>.<span
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| − | style='mso-spacerun:yes'> </span>Please attach a more detailed proposal <o:p></o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'>(i.e., 1-2 pages), including
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| − | a description of the population from which research participants will be drawn
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| − | (e.g., university students, nursing home residents) and a discussion of how
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| − | research participants will be solicited. Also attach copies of research
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| − | instruments (e.g., questionnaires, interview guides). <o:p></o:p></span></b></p>
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'>Assessment of Risk to Human
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| − | Participants: [ </span></b><i style='mso-bidi-font-style:normal'><span
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| − | lang=EN-US style='font-size:11.0pt;mso-bidi-font-size:10.0pt'>attach additional
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| − | page(s) if necessary </span></i><b style='mso-bidi-font-weight:normal'><span
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| − | lang=EN-US style='font-size:11.0pt;mso-bidi-font-size:10.0pt'>] <o:p></o:p></span></b></p>
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| − | 12'> </span><o:p></o:p></span></u></b></p>
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| − | style='font-size:11.0pt;mso-bidi-font-size:10.0pt'>Description of Procedures to
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| − | be Undertaken to Reduce Risk to Human Subjects.<span style='mso-spacerun:yes'>
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| − | </span>Please attach copies of consent forms and other similar documents.<o:p></o:p></span></b></p>
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| − | 12'> </span><o:p></o:p></span></u></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US>I
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| − | have read the <st1:place w:st="on"><st1:PlaceType w:st="on">UNIVERSITY</st1:PlaceType>
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| − | OF <st1:PlaceName w:st="on">ALBERTA STANDARDS<span style='mso-spacerun:yes'>
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| − | </span>FOR THE PROTECTION OF HUMAN RESEARCH PARTICIPANTS</st1:PlaceName></st1:place>
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| − |
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| − | [GFC Policy Manual, Section 66] and agree to abide by these standards in
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| − | conducting my research.<o:p></o:p></span></b></p>
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US><o:p> </o:p></span></b></p>
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US><span
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| − | style='mso-spacerun:yes'> </span><u><span style='mso-tab-count:5'> </span></u><span
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| − | style='mso-spacerun:yes'> </span>Signature of Principal Investigator(s)</span></b><b
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| − | style='mso-bidi-font-weight:normal'><span lang=EN-US style='font-size:11.0pt;
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| − | mso-bidi-font-size:10.0pt'><o:p></o:p></span></b></p>
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| − | 5'> </span></span></u></b><b
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| − | style='mso-bidi-font-weight:normal'><span lang=EN-US style='font-size:11.0pt;
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| − | mso-bidi-font-size:10.0pt'><span style='mso-spacerun:yes'> </span></span><span
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| − | lang=EN-US>Date</span></b><span lang=EN-US> <span style='mso-tab-count:5'> </span></span></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US><o:p> </o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US>(If
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| − | Student)<o:p></o:p></span></b></p>
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US><o:p> </o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US>___________________________________<span
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| − | style='mso-spacerun:yes'> </span>Signature of Faculty Supervisor/sponsor<o:p></o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US><o:p> </o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US>___________________________________<span
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| − | style='mso-spacerun:yes'> </span>Date<o:p></o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US><o:p> </o:p></span></b></p>
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| − | <p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span lang=EN-US><o:p> </o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal><!--[if gte vml 1]><v:shapetype id="_x0000_t202"
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| − | coordsize="21600,21600" o:spt="202" path="m,l,21600r21600,l21600,xe">
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| − | <v:path gradientshapeok="t" o:connecttype="rect"/>
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| − | margin-left:111.6pt;margin-top:11.2pt;width:4in;height:115.2pt;z-index:1'
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| − | o:allowincell="f"/><![endif]--><![if !vml]><span style='mso-ignore:vglayout'>
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| − | <tr>
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| − | <td width=148 height=14></td>
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| − | </tr>
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| − | <tr>
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| − | <td></td>
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| − | <td width=390 height=160 bgcolor=white style='border:.75pt solid black;
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| − | vertical-align:top;background:white'><![endif]><![if !mso]><span
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| − | style='position:absolute;mso-ignore:vglayout;z-index:1'>
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| − | <table cellpadding=0 cellspacing=0 width="100%">
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| − | <tr>
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| − | <td><![endif]>
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| − | <div v:shape="_x0000_s1026" style='padding:4.35pt 7.95pt 4.35pt 7.95pt'
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| − | class=shape>
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| − | <p class=MsoNormal align=center style='text-align:center'><b
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| − | style='mso-bidi-font-weight:normal'><span lang=EN-US style='font-size:11.0pt;
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| − | mso-bidi-font-size:10.0pt'>Submit completed form and attached documents to:<o:p></o:p></span></b></p>
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| − | <p class=MsoNormal align=center style='text-align:center'><b
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| − | style='mso-bidi-font-weight:normal'><span lang=EN-US style='font-size:11.0pt;
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| − | mso-bidi-font-size:10.0pt'><o:p> </o:p></span></b></p>
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| − | <p class=MsoNormal align=center style='text-align:center'><b
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| − | style='mso-bidi-font-weight:normal'><span lang=EN-US style='font-size:11.0pt;
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| − | mso-bidi-font-size:10.0pt'>Dr. Lynn Penrod, Chair<o:p></o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal align=center style='text-align:center'><b
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| − | style='mso-bidi-font-weight:normal'><span lang=EN-US style='font-size:11.0pt;
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| − | mso-bidi-font-size:10.0pt'>Arts, Science, Law Research Ethics Board<o:p></o:p></span></b></p>
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| − | <p class=MsoNormal align=center style='text-align:center'><b
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| − | style='mso-bidi-font-weight:normal'><span lang=EN-US style='font-size:11.0pt;
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| − | mso-bidi-font-size:10.0pt'>Dept of Modern Languages and Cultural Studies<o:p></o:p></span></b></p>
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| − | <p class=MsoNormal align=center style='text-align:center'><b
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| − | style='mso-bidi-font-weight:normal'><span lang=EN-US style='font-size:11.0pt;
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| − | mso-bidi-font-size:10.0pt'>200 Arts Building<o:p></o:p></span></b></p>
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| − | <p class=MsoNormal align=center style='text-align:center'><span lang=EN-US><a
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| − | href="mailto:lpenrod@ualberta.ca">mailto:lpenrod@ualberta.ca</a></span><b
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| − | style='mso-bidi-font-weight:normal'><span lang=EN-US style='font-size:11.0pt;
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| − | mso-bidi-font-size:10.0pt'><o:p></o:p></span></b></p>
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| − | <p class=MsoNormal align=center style='text-align:center'><b
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| − | style='mso-bidi-font-weight:normal'><span lang=EN-US style='font-size:11.0pt;
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| − | mso-bidi-font-size:10.0pt'><span style='mso-spacerun:yes'> </span><span
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| − | style='mso-spacerun:yes'> </span>Phone: 492-1199<span
| |
| − | style='mso-spacerun:yes'> </span></span></b><b
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| − | style='mso-bidi-font-weight:normal'><span lang=EN-US style='font-size:8.0pt;
| |
| − | mso-bidi-font-size:10.0pt'>January 2006</span></b><b style='mso-bidi-font-weight:
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| − | normal'><span lang=EN-US style='font-size:11.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></b></p>
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| − |
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| − | <p class=MsoNormal align=center style='text-align:center'><span lang=EN-US><o:p> </o:p></span></p>
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| − | </div>
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| − | <![if !mso]></td>
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| − | </tr>
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| − | </span><![endif]><![if !mso & !vml]> <![endif]><![if !vml]></td>
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| − | </span><![endif]><span lang=EN-US style='font-size:11.0pt;mso-bidi-font-size:
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| − | <p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;mso-bidi-font-size:
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| − | 10.0pt'><o:p> </o:p></span></p>
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| − |
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| − | <p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;mso-bidi-font-size:
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| − | 10.0pt'><o:p> </o:p></span></p>
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| − |
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| − | <p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;mso-bidi-font-size:
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| − | 10.0pt'><o:p> </o:p></span></p>
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| − |
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| − | <p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;mso-bidi-font-size:
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| − | 10.0pt'><o:p> </o:p></span></p>
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| − | <p class=MsoNormal><span lang=EN-US style='font-size:11.0pt;mso-bidi-font-size:
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| − | 10.0pt'><o:p> </o:p></span></p>
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| − |
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| − | 10.0pt'><o:p> </o:p></span></p>
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| − | </nowiki>
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