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Posted: December 27th, 2022


Application for
HREC Approval
Total word limit for this assessment item is 2000 words

Project title:

What type of project is this? (Tick as many as apply)
Masters project Clinical Trial Postgraduate Diploma
Undergraduate Student Research Project Honours
PhD Staff Research Project Other
Through which School/Section is the research to be conducted?


Principal Researcher (STAFF MEMBER ONLY)
Title & Name: Dr Amany Abdelkader
Position: Lecturer
School/Section: School of Health
Phone number: 5122 6014
Email address: [email protected]
Please list academic qualifications: PhD, GradCertEd (Tert)
Describe what this researcher will do in
the context of this project: The lead researcher will be an expert guide though all
aspects of the project.
Include a brief summary of relevant
experience for this project: Supervision of higher degree students, multiple
publications to peer reviewed journals and successful
competitive grants applications.

Student/Other Researcher/s
Title & Name:
Phone number:
Email address:
Student ID number:
Please list academic qualifications:
Describe what this researcher will do in
the context of this project:
Include a brief summary of relevant
experience for this project:
Sample Application for
HREC Approval

Provide a brief outline of the project describing in everyday, jargon-free language the key aspects of
the research (e.g., who will be participating, what information will be collected and by what means,
what participants will be required to do, etc.) and the key research aims. (300 words max.)

State the aims, key research questions, and significance of the project. Also provide a brief
description of the relevance of your proposed project to current research, supported by the literature.
(500 words max.)
Sample Application for
HREC Approval

Provide an outline of the proposed method, including details of data collection techniques, tasks
participants will be asked to do, the estimated time commitment involved, and how data will be
analysed. (500 words max).

Participant Details
Describe your proposed recruitment strategy to source target participants. Provide the number and
age range, giving a justification of your proposed sample size. (100 words)
Target participants
Who are the target participants? (Tick as many as applicable)

Students or staff of this University
Adults (over the age of 18 years and competent to give consent)
Children/legal minors (under the age of 18 years, with parental consent)*
Elderly individuals
Individuals from non–English-speaking backgrounds
Pensioners or welfare recipients
Sample Application for
HREC Approval

Intellectually or mentally impaired individuals unable/with compromised capacity to provide
Physically disabled individuals
Patients or clients
Prisoners, parolees, or wards of the state
Individuals highly dependent on medical care with a compromised capacity to give consent
Aboriginal and/or Torres Strait Island communities
Women who are pregnant and the human foetus
People who may be involved in illegal activities
*Parental consent may not be required in some instances – refer National Statement, 4.2.8 & 4.2.9

This section raises the issue of your duty of care toward research participants. To what risks are
participants subjected? What will you do should an emergency occur, or should a participant become
upset or distressed? What is your risk management strategy?
Refer National Statement: Section 2.1 Risk and Benefit
Research Activities
Which of the following activities will the research involve? (Tick as many as apply)

Use of a questionnaire (attach copy)
Interviews (attach interview questions)
Observation of participants without their knowledge
Participant observation
Audio- or video-taping of interviewees or events
Access to personal and/or confidential data (including student, patient or client data) without
participants’ specific consent
Administration of any stimuli, tasks, investigations or procedures which may be experienced
by participants as physically or mentally painful, stressful or unpleasant during or after the
research process
Performance of any acts which may diminish the self-esteem of participants or cause them to
experience embarrassment, regret or depression
Use of non-treatment of placebo control conditions
Collection of body tissues or fluid samples
Sample Application for
HREC Approval
Identify as far as possible all potential risks to participants (e.g., physical, psychological, social, legal,
economic) associated with the proposed research. Explain what risk management procedures will
be put in place, along with contact details of an appropriately qualified organisation for participant
reference in case of distress, eg: Lifeline (200 words)

Obtaining and Documenting Consent

How will informed consent be obtained/recorded?
Signed consent form
Recorded verbal consent
Implied by return of survey
Other (Please specify):


Tick which method will be used to guarantee confidentiality/anonymity?
Non-identifiable (anonymous) data, which have never been labelled with individual
identifiers or from which identifiers have been permanently removed, and by means of
which no specific individual can be identified.
Re-identifiable data, from which identifiers have been removed and replaced by a code,
but it remains possible to re-identify a specific individual by, for example, using the code or
linking different data sets.
Individually identifiable data, where the identity of a specific individual can reasonably be
ascertained. Examples of identifiers include the individual’s name, image, and date of birth
or address.
Security and Storage

Does the Principal Researcher accept responsibility for the security of the data
collected? Yes

Who will have access to data?
Access by named researchers only Access by other(s) than named researcher(s)
Sample Application for
HREC Approval

Which of the following methods will be used to ensure data security?
Data will be kept in locked filing cabinets
Data and identifiers will be kept in separate, locked filing cabinets
Access to computer files will be available by password only
Other (please describe)

Please check that the following documents are included in your application by writing in the box
below (300 words)

Are the following research tools are included in this
application? Yes No N/A
Questionnaire Draft
Interview Questions Draft
Sample Application for
HREC Approval

Researcher Declarations:

The information contained herein is, to the best of my knowledge and belief, accurate. I have read
the University’s current human ethics guidelines, and accept responsibility for the conduct of the
procedures set out in the attached application in accordance with the guidelines. I and my co
researchers have the appropriate qualifications, experience and facilities to conduct the research set
out in the attached application and to deal with any emergencies and contingencies related to the
research that may arise.
Principal Researcher
(Print name in block letters)
Date: ……./……../……..
Other Researcher
(Print name in block letters)
Date: ……./……../…….. Other Researcher
(Print name in block letters)
Date: ……./……../……..

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