FOR OFFICE USE ONLY

Received by:

Date:

Ethics Submission Form

Faculty of Education, Health and Well-being

 You must complete all sections of this form in as much detail as possible (word counts are given if
necessary.) If your form is incomplete, it will be returned to you to resubmit.
 You must be given approval for your research project from the University before you can begin.
 Applications should be submitted by 1st of each month to fehwethics@wlv.ac.uk
 Applications will be reviewed and a response given by 30th/31st of the same month unless you are
notified otherwise.

In light of the Covid-19 global crisis, you need to confirm the following:

1. I confirm that the research will fully comply with current government guidance on social distancing, hygiene,
travel, etc.
2. I confirm that the research will fully comply with any relevant current statutory body guidelines on
conducting research online or in the context of Covid-19 (e.g. BPS, DFE, etc.)
3. I understand that it is my responsibility to update this submission and I will obtain further approval if there
are any changes required to the activities within the project at the time of data collection.

Section One

First Name: Enter First Name here University Student Enter your student
Number: number here if applicable
Surname: Enter Surname here Daytime Contact Number: Enter a contact number
University Email Enter your University email (in case we need to contact you) here
Address: address only
Name of Project Supervisor, Director of Studies or Principal Enter names here
Investigator:

Is this study

Subject area your research/project is located (Please check all that apply)
FEHW FSE
Education FABSS
Health COLT
Sport Cross University Project
Psychology Other (Please give details below)
Social Care or Social Work

Please indicate the category of project that you are applying for? See RPU website here
Choose an item.

Give details of service user involvement in the development and/or completion of the research.
Click here to enter text. This box will expand as required.

Please provide a start and end date for your project.

Start Date: Click or tap to enter a date.

End Date: Click or tap to enter a date.
Section Two

2.1 Project title:

Click here to enter text. This box will expand as required.

2.2 Give details of proposed research questions/hypothesis

Click here to enter text. This box will expand as required.

2.3 Briefly outline your project, stating the rationale, aims and expected outcomes (300 words)
Click here to enter text. This box will expand as required.

2.4 How will your research be conducted? (750 words max)

Describe the methods so that it can be easily understood by the Ethics Committee. Ensure that acronyms and subject specific terminology are
clearly explained.
Click here to enter text. This box will expand as required.

2.5a Does your research involve children under 18 years of age?

2.5b If yes, do you have an Enhanced Disclosure Certificate from the Criminal Records Bureau/Disclosure and Barring
Service

2.6 Are participants in your study going to be recruited from a potentially vulnerable group? See RPU website here
Choose an item.
If you have answered ‘Yes’ above, click here to enter text.

2.7 How will your data be analysed?

Click here to enter text. This box will expand as required.

2.8 Is ethical approval required by an external agency? (e.g. NHS, other university, outside organisation)
Choose an item.
Enter contact details here of person who can verify ethical approval if necessary.

2.9 What, in your view, are the ethical considerations involved in this project? (e.g. confidentiality, consent, risk, physical or
psychological harm, etc.) Please explain in full sentences. Do not simply list the issues. Please make it clear how you are going to deal with
issues with regard to your own welfare and safety.

Confidentiality Intervention
Consent Intervention
Participants under 18 Intervention
Click here to enter another area. Intervention
Click here to enter another area. Intervention

2.10 Have participants been/will be fully informed of the risks and benefits of participating and of their right to
refuse participation or withdraw from the research at any time?
Choose an item.
Click here to enter text if required.

2.11 How will you ensure that the identity of your participants is protected? See RPU website here
Click here to enter text. This box will expand as required.

2.12 How will you ensure that the data remains confidential? See RPU website here
Click here to enter text. This box will expand as required.

2.13 How will you store your data during and after the project? See RPU website here

(Ethics Form v5, Mar 22)

Click here to enter text. This box will expand as required.

2.14 Please list references.

Click here to enter text. This box will expand as required.

Section Three

3.1 Is this data set of potentially illicit origin?*

*We may need to consider requests for ethical approval from researchers using data that was obtained without the consent of the original
data owners or data subjects.

3.2 Does your research fit into any of the following security-sensitive categories? See RPU website here
Security Sensitive Category
Commissioned by the military
Commissioned under an EU security call
Involve the acquisition of security clearances
Concerns terrorist or extreme groups

If you have answered yes to any part of question 3.2 please ensure that you complete questions 3.3 – 3.8

3.3 Does your research involve the storage on a computer of any records, statements or other documents that can
be interpreted as promoting or endorsing terrorist acts?

3.4 Will your research involved the electronic transmission (e.g. as an email attachment) of any records or
statements that can be interpreted as promoting or endorsing terrorist acts?

3.5 Do you agree to store electronically on a secure University file store any records or statements that can be
interpreted as promoting or enduring terrorist acts? Do you also agree to scan and upload any paper documents
with the same sort of content? Access to the file store will be protected by a password unique to you.
Choose an item.
If you have chosen ‘No’ click here to enter text.

3.6 Do you agree NOT to transmit electronically to any third party documents in the University secure document
store?

3.7 Will your research involve visits to websites that might be associated with extreme or terrorist organisations? See
RPU website here
If you have chosen ‘Yes’ click here to enter text.

3.8 You are advised that visits to websites that might be associated with extreme or terrorist organisations may be
subject to surveillance by the police. Accessing those sites from University IP addresses might lead to police
enquiries. Do you understand this risk?

Section Four
4.1 Appendices (All submissions) Please list the items that you are submitting with this document. (These will need to be submitted to
FEHWEthics@wlv.ac.uk ) You may want to include additional information that will help the panel with their decision such as your proposal.
You need to provide examples of research instruments, recruitment posters and leaflets, information sheets (age appropriate) assent forms
(for children), consent forms, risk assessment if research is carried out abroad.
Click here to enter text. This box will expand as required.

(Ethics Form v5, Mar 22)

Section Five
Confirmation of Ethical Approval and Feedback on Submission
TO BE COMPLETED AS INDICATED, BY MODULE LEADER, SUPERVISOR AND/OR HEAD OF ETHICS PANEL

Submission Number: Enter submission number

Date of Review: Click here to enter a date.

Identified Category
On behalf of members of staff and students, I can confirm that the proposal for research being made by the above
student/member of staff is

Checklist required for Category B Proposals:

Outline summary: rationale and expected benefits from the study, with a statement of what the researcher is Yes/No
proposing to do and how
Explanation of the methodology to be used Yes/No
An information sheet and copy of a consent form to be used with subjects Yes/No
Details of how information will be kept Yes/No
Details of how results will be fed back to participants Yes/No
Letter of consent from any collaborating institutions Yes/No
Letter of consent from head of institution wherein any research activity will take place Yes/No

Decision
I confirm that the proposal for research being made by the above student/member of staff is
Choose an item.

Comments and Feedback: Click here to enter text. This box will expand as required.

Proposed Actions: Click here to enter text. This box will expand as required

For a student’s proposal: Name of module leader or supervisor giving approval: Click here to enter name.

For a member of staff’s proposal: Name of Head of Ethics Panel giving approval: Click here to enter name.

Signed (This form must have a valid signature): Click here to paste signature.
Date: Click here to enter a date.

(Ethics Form v5, Mar 22)