HomeERCCDigital application form

Digital application form

Fill Checklist for protocols to be submitted to the CAMBIN ERCC

Files for submission to the CAMBIN ERCC shall comprise the documents listed below. To avoid delay, it is the responsibility of the researcher to ensure that his/her file is complete before submission. All documents should be submitted via this online platform. We no longer receive hard copies.

    1. CAMBIN ERCC Application form (online application form)
    2. A complete copy of the research proposal
    3. Curriculum vitae of the principal investigator and co-investigator(s). In the case of a student thesis/dissertation, the CV of his/her supervisor (s) and that of the student plus an attestation of the supervisor indicating that he/she is supervising the study).
    4. Consent forms/information sheets to be used for the enrolment of research participants in both English and French
    5. Where applicable, insurance forms for research participants
    6. Where applicable, questionnaires to be used in the study
    7. Where applicable, evidence of scientific review and approval by the investigator’s institution
    8. The work plan for the study
    9. Budget
    10. Proof of payment of required fees (see below)

 

 

 

Instructions:

Complete ALL fields. For those that are not applicable, write ‘Not Applicable’ ”. 

Section 1– Project Summary

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Section 2 – Details of Principal Investigator

If the application is a student project, please name the student’s supervisor as the co- Investigator.

Section 3 – Co-Investigators/Collaborators

If there are more than 2 co-investigators, please ensure they are listed in the protocol.

Section 3– Project Summary

Section 4: Project Details

Provide details of the scientific justification for the study, and the research methodology (max 750 words).
Provide explain the scientific and/or public health value of the study (max 200 words).
Please state where the study will take place. If part or all of the study will take place abroad, please state steps that have been taken to ensure compliance with research ethics requirements in those countries.
Provide information on how the study results will be disseminated to various stakeholders (max 200 words).
2. 4.e Previous ethical approval (Indicate Yes or No) – Please attach the relevant documentation in protocol
Please attach the relevant documentation in protocol
Max. file size: 64 MB.
Has this proposal been submitted to another research Ethics Committee?(Required)
Has any part of this proposal received prior ethical approval?(Required)
Has any part of this proposal previously been rejected by an ethics committee?(Required)
Has this project received funding, or is in the process of receiving funding?(Required)

Section 5 – Research Participants

Please give details of any vulnerable groups to be used in the study (e.g. those under 21years, prisoners, the mentally ill), and give reasons for their inclusion.
Please explain how you will recruit participants to the study. Include any incentives or financial reimbursement). If advertising is to be used, please attach a copy of the advert. If you are planning to recruit via email, please include a copy of the email.
Please describe the process for ensuring that all participants provide informed consent taking into consideration any specific requirements for vulnerable persons/populations (Please include a copy of the consent form and participant information sheet and any additional forms/information if appropriate in the protocol document).
Please state measures and procedures in place for the withdrawal of participants from the study.
Please state the measures you have taken to ensure the confidentiality of the research participants and the data collected both during and after the study, including who will have access to the data.

Section 6 – Risks and Benefits

Please state any potential risks/hazards, medical or non-medical and mechanisms to minimise them.
Please provide details of any potential benefits to:
Would you be willing to attend a CAMBIN ERCC meeting to answer questions about your proposal?(Required)
Any attendance must be by the PI named in the section one of this application form.

Declaration of Principal Investigator

I declare that: • All information provided by me on this form is correct. • If the study receives research ethics clearance from the CAMBIN ERCC, I will report to the ERCC, any adverse or unforeseen events which occur within 7 days. • If the study receives research ethics clearance from the CAMBIN ERCC, I will provide an annual progress report of the project until the end of the study. • If the study receives research ethics clearance from the CAMBIN ERCC, I will provide notification of the end or early termination or suspension of the research project. • I will inform the ERCC if there are any changes to the research protocol or personnel which affect the ethical aspects of the project. • I will assist the ERCC in any continuing review of the project as deemed necessary
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