Ethical Clearance Form for Dissertation

This assignment provides a detailed Ethical Clearance Form template required for dissertation submissions. It covers essential sections like personal information, proposed research timeline, ethical considerations (informed consent, data protection), and data storage/disposal plans. The form emphasizes adherence to the Regent Business School's Code of Conduct for Research and requires supervisor approval.

The University of Melbourne
ETHICAL CLEARANCE FORM
Section 1 : Personal Details
1.1 Full Name and Surname
1.2 Student Number
1.3 Contact Details:
 Telephone Number
 Cell Number
 Email:
Supervisor’s Details:
 Name:
 Telephone Number
 Email
Section 2: Dissertation Description
2.1 Dissertation title
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2.2 Proposed work plan
Steps
Chapter One
Chapter Two
Chapter Three
Chapter Four
Chapter Five
Dates
Section 3 : Ethical Issues
The RBS Research Ethics Policy applies to all members of staff and post graduate student who are
involved in research on or off the RBS campus. In addition any person not affiliated with RBS who
wishes to conduct research with RBS students and/ or staff is bound by the same ethics framework.
All students and staff members are to familiarise themselves with and sign an undertaking to comply
with RBS’s “Code of Conduct for Research”
Question 3.1
Will data collection involve any of the following Yes No
Access to confidential information without prior consent of participants
Participants being required to commit an act which might diminish self respect or cause
them to experience shame, embarrassment or regret
Participants being exposed to questions which may be experienced as stressful or
upsetting, or to procedures which may have unpleasant or harmful side effects
The use of stimuli, tasks or procedures which may be experienced as stressful, noxious or
unpleasant
Any form of deception
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If “YES” explain and justify. Explain what steps you will take to minimise the potential stress/ harm.
Question 3.2
Will any of the following instruments be used for purposes of data collection YES No
Questionnaire
Survey schedule
Interview schedule
Assessment instruments
If “YES” attach a copy of the research instrument
Question 3.3
Will the autonomy of participants be protected through the use of and informed consent
form, which specifies [in language respondents will understand]
YES NO
The nature and purpose/ s of the research
The identity and institutional association of the researcher and supervisor/ project
leader and their contact details
The fact that participation is voluntary
The responses will be treated in a confidential manner
Any limits on confidentiality which may apply
The anonymity will be ensured where appropriate [e.g. coded/ disguised names of
participants/ respondents/ institutions]
The fact that participants are free to withdraw from the research at any time without
any negative or undesired consequences to themselves
If NO, this needs to be explained and justified. The measures to be adopted to ensure that the
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respondents fully understand the nature of the research and the consent that they are giving.
Question 3.4
Storage and Disposal of Research Data
Data collected must be scanned and copied onto a CD and sent to RBS for storage. This data will be
kept by RBS for a period of at least FIVE years.
How will the research data be disposed of? Please provide specific information e.g. shredding of
documents, incineration of videos, cassettes etc.
Question 3.5
In the subsequent dissemination of your research findings – in the form of a finished dissertation,
publication etc – how will the anonymity/ confidentiality be protected
Question 3.6
Has any organisation/ company participating in the research or funding the project , imposed any
conditions to the research : YES/NO
If YES, indicate what the conditions are:
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SECTION 4 : FORMALISATION OF THE APPLICANT
APPLICANT
I have familiarised myself with RBS’s Code of Conduct for Research and undertake to comply with it.
The information supplied above is correct to the best of my knowledge.
Signature of Applicant: Date:
[Ensure that the check list on this form is complete]
SUPERVISOR
Ensure that the applicant has completed the attached check list and that the form is forwarded to
the RBS’s Research Dept
Signature of Supervisor: Date:
RECOMMENDATION OF THE RESEARCH DEPT
The Applicant is:
Approved
Recommended and referred to the Ethics Committee for further consideration
Not Approved, referred back for revision and resubmission
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Name of Head: Signature
Date:
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