Research in more than 1 Please state countries: country Research to be conducted in Details: 1 institution ** Research is Please give details: ** ** In certain cases, consent is required from the institutions where the research will be undertaken (such as a hospital, clinic or school) and the relevant national, provincial and local health or educational authorities. In some of these cases, however, ethical clearance in Da Vinci is a for these institutions and/or authorities prior to considering the for access student’s request to the research site. SECTION 4: FORMALISATION OF THE APPLICATION APPLICANT AND SUPERVISOR I have familiarised myself with the Da Vinci Research Ethics Policy and undertake to Institute’s comply with it. The information supplied above is correct to the best of my knowledge. NB: PLEASE ENSURE THAT THE ATTACHED CHECK SHEET IS COMPLETED SIGNATURE OF APPLICANT DATE SIGNATURE OF SUPERVISOR DATE RECOMMENDATION OF RESEARCH COMMITTEE The application is (please tick): * Council has delegated powers to Research Committee to: - Approve Masters and Doctoral academic research projects NAME OF CHAIRPERSON: __________________________________SIGNATURE:___________________________ DATE ………………………………………
Research in more than 1 country Please state countries: Research to be conducted in 1 institution ** Details: Research is ** Please give details: ** In certain cases, consent is required from the institutions where the research will be undertaken (such as a hospital, clinic or school) and the relevant national, provincial and local health or educational authorities. In some of these cases, however, ethical clearance in Da Vinci is a for these institutions and/or authorities prior to considering the student’s request for access to the research site. SECTION 4: FORMALISATION OF THE APPLICATION APPLICANT AND SUPERVISOR I have familiarised myself with the Da Vinci Institute’s Research Ethics Policy and undertake to comply with it. The information supplied above is correct to the best of my knowledge. NB: PLEASE ENSURE THAT THE ATTACHED CHECK SHEET IS COMPLETED SIGNATURE OF APPLICANT DATE SIGNATURE OF SUPERVISOR DATE RECOMMENDATION OF RESEARCH COMMITTEE The application is (please tick): * Council has delegated powers to Research Committee to: - Approve Masters and Doctoral academic research projects NAME OF CHAIRPERSON: __________________________________SIGNATURE:___________________________ DATE ………………………………………
Ethical-clearance-application-form-Da-Vinci-Institute.docx