Request for Ethical Review 
                                                   For Research Involving Humans
                                      Approved by RRU Academic Council 
                                                  September 20, 2012 
                   If your research involves human participants then it most likely requires an ethical review by the 
                   Royal Roads University Research Ethics Board (or one of its subcommittees). Please refer to the 
                   Royal Roads University Research Ethics Policy for specific guidance on identifying research that 
                   requires ethical review. 
                   The Royal Roads University Research Ethics Policy will assist you in understanding the questions
                   below and will help you formulate your responses. If you have additional inquiries, contact your 
                   Project Advisor or Academic Supervisor or the Research Ethics Coordinator.
                   Research involving human participants cannot be initiated until the Request for Ethical 
                   Review has been approved. (This includes sending out invitations for participation, as well
                   as any data-gathering.)
                   Incomplete requests for Ethical Review will not be considered – all questions must be answered 
                   and all requested attachments provided.
                   Please do not delete any of the questions or prefatory materials. If you need more space than 
                   provided, please attach additional blank sheets.  Please remember to note the number of your 
                   response.
                   Please have your academic supervisor submit the completed form, via email, to ethicalreview@ 
                   royalroads.ca. Please allow four weeks for the decision of the Research Ethics Board.
                   If you use this template please ensure that all notes in blue are removed before 
                   sending for review
                       I.     PRINCIPAL INVESTIGATOR 
                   Name:
                   Note: When you are conducting research in your own organization, we also need to know 
                   your position in the organization in order to determine where you sit in the organizational 
                   hierarchy vis-à-vis potential participants in the research. This helps to assess power-over 
                   and/or conflict of interest. Please include these details here or in the section on conflict of 
                   interest below.
                   Faculty / Program:
                   (Please specify)
                                        Faculty    Graduate Student    Undergraduate Student     Staff
                                        Other (Please Specify):
                       A. CONTACT INFORMATION
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                                                              Request for Ethical Review 
                                                      For Research Involving Humans
                    Address:
                    City:                                                           Province:
                    Postal Code:
                    Home Phone:     (         )                    Work Phone:    (         )
                    Cell Phone:     (         )                    Other:         (         )
                    E-Mail:
                                    Please use the current email address which you check regularly. Correspondence and/or 
                                    approval will be sent to this address.
                    If Student, specify: 
                    FACULTY PROJECT ADVISOR / ACADEMIC SUPERVISOR 
                    Name:
                    Office Phone:   (         )                    Extension:
                    E-Mail:
                                    Faculty Members Only - Specify Your Supervisor:
                    Supervisor:
                    If applicable, specify: 
                    SPONSOR / CLIENT
                    Name:
                    Same issue as above re: your sponsor’s position in the organization. This helps to assess 
                    power-over and/or conflict of interest. Please include these details here or in the section 
                    on conflict of interest below.
                    Company:
                    Office Phone:   (         )                    Extension:
                    E-Mail:
                    If Faculty member, specify: 
                    SUPERVISOR AND SCHOOL/FACULTY 
                    Name of 
                    Supervisor:
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                                                              Request for Ethical Review 
                                                      For Research Involving Humans
                    Office Phone:   (         )                    Extension:
                    E-Mail:
                                    Faculty Members Only - Specify Your Supervisor:
                    Your School/ 
                    Faculty:
                    CO-INVESTIGATORS (If Any)
                    Name, position, and if applicable, affiliation with other institution, mailing address, email address, 
                    and telephone.
                        B. CONFLICT OF INTEREST
                    Provide full details of any actual, perceived, or potential conflicts of interest (economic, 
                    family-related or otherwise) on the part of the principal investigator and/or co-
                    investigators.   For example, if you plan to incorporate into your research staff whom you 
                    employ, students whom you teach, or fellow employees, this constitutes a conflict of 
                    interest. Because the researcher has power over potential participants in areas outside of 
                    the research, such individuals may perceive their participation to be coerced, and are 
                    therefore not fully free to refuse participation in your research, regardless of your best 
                    intentions. Please indicate how you would acknowledge and address this issue.  What 
                    measures would you take to ensure research participants are aware of potential or actual 
                    conflict?  Any and all conflicts of interest must be disclosed in your consent 
                    documentation (as outlined in Question IX).
                    Please see the Tri-Council guidelines for Conflict of Interest here:
                    http://ethics.gc.ca/eng/policy-politique/initiatives/tcps2-eptc2/chapter7-chapitre7/#toc07-1 
                    If the researcher might be perceived as benefitting over and above any benefits associated
                    with completing a Master’s degree, please explain them here. For example, if the results of
                    the study will benefit – or will be perceived as disproportionately benefitting – the 
                    researcher (or researcher’s family members) in terms of reputation or economic status, it 
                    is best to disclose these up front. 
                    Conflicts of interest should be avoided wherever possible. If there is a serious conflict of 
                    interest, students’ proposals may be rejected and/or may need to go through a full, rather 
                    than an expedited, review.
                    Take into account any real or perceived conflicts of interest related to the supervisor, 
                    sponsor, or inquiry team members.
                    Do you supervise or have influence over individuals in the study? If so, please explain 
                    how you would minimize undue influence over these individuals?
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                                                        Request for Ethical Review 
                                                 For Research Involving Humans
                  Explain here how you are mitigating any power-over relationships between your potential 
                  participants and you, your supervisor, your sponsor, and/or your inquiry team members. 
                  When the study might provoke controversy or difficult feedback, potential participants 
                  with whom you have direct power-over should be excluded as they may experience a 
                  sense of coercion in the study and therefore will not be able to give their voluntary (free) 
                  consent.
                  Drawing upon the support of a neutral third party facilitator or inquiry team member may 
                  be a possibility when direct reports are involved. If applicable, please ensure these details 
                  are included in information communicated with potential participants (appendices).
                  Is there any possibility that the activities or results of your study could impact negatively 
                  on the organization? 
                  Yes           No    
                  If Yes in what ways might the activities or results of your study impact negatively on the 
                  organization? If this is a potential outcome, please explain how you would mitigate this 
                  impact.
                     II.    SHORT TITLE OF PROJECT
                  Project Title: (10 Words 
                  Max.)
                                         1.
                  Provide 4 keywords /   2.
                  phrases that describe 
                  the project:           3.
                                         4.
                     III.   SUMMARY OF PROPOSED RESEARCH
                  Provide a brief but complete description, in non-technical language, of the purpose, 
                  objectives and research questions of the project. Use no more than one page. 
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