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  • 8/14/2019 Ethics Dementia Group

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    Therapeutic Arts & Gomplementary MedicineFaculty of Education, Health and Sciences

    Tel No.olllil ib1J+! lrtl,"r.y)L .ir I r b i: i ?4 (O"r,t" Jcl"i9 i {,e licl il,.^,*r.)e l.l;., rJ')!LtJ; f 1'*,..^-\'\?11 r+,i .r{lCi: il-{i1,.,'.'l

    Tiile or topic erea of proposed study

    What are the aims and

    Ac*esrsix 2 - Rs*uest for Ethical Asproval for lndividual Study /Programme of ResearchReouest.For Ethical Approval Fgr lndivic!r-ra! Stlrdrr I p:nqramr,o nfResearch

    Your Name: ti -t.li l1+rrr-.'* o" r'' .r.-..:,r .., a.in.c" Cia..q... 1., I i SchoollResearch centre {if internal applicant}: FCr.lcation. Health and Sciences-tj*; ,. I tr^1 l;rr--_)1ll {8..,,

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    t,ti-c q,ldg, cd 7 (rl)e-r-r,r.r.r:r.-rtr-l c;ra..pif.hr',-rr.t-ei- wer'lcf ,-tuyi,.'^1 c.)cJ ncot-v^tr-fitliLcl,n,rnuuurcc-tr.-',\f.i.i.,.'l,-ut rt"' Jrr'rJ;cl li-.^i "d we-rJrc'i t'-l''/'rr.1) F ccrt}tlltclqra.L..n l-"n Fh.'\or.." clc"^n lr;',prl-gr-l , cuHa,rcl ,.\ .-"r. H".a Sc-.rr,r.e. cl&.1 , t,,rFh l-{nr sc{-*a.1,,..,1"1 , (a...,-.1,^.1 i-p o:,/,r-Tv\,r's" ,-,>tcl l-L /cr.e..Fe sl-2.-i'ht^ l-o-'cc'"ytu-e ,'--tH".: *ri'ifJ;T:. .i ffi;' ;. Xff:,,ff.', ;"H;fr -:;,0' ).^f"CV\tr cr C. - '-1tc|-nllr- pLrt 6-LTh-l ,,- reai-l \ cr,l sr'llr-r.llr-r^-k i',',',Fc,-hc-u'r *L,^,icil-i^.*,-,-'.1 ci t*c,;rhl-r,.'r,^-+-1\.\-r crzr ec,t*La.rr-.1- a*ft-cn^a,r ,"^,ri{ 4^^t, L I r crt} ., raqV ( f* ,*J "r-' Qzul:llcn ' i clLrhlf.into*f t,i,-.,t^L&1i-{ cir*C i la gl1,E hu--c *J,",^-, \l

  • 8/14/2019 Ethics Dementia Group

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    Therapeutic Arts & Complementary Mediein+Faculty of Education, Health anci $ciencesO'-rtline of study design and methods

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    age, and if appropriate, inclusion and exclusion Griteria'samplo, covering selection, number,

    r.\or^i i r1,Tei,,r4 i4f >o:nr*q-^ffj rs..r-t pift241:, i llirrnrrdrDj

    irde to the participants? lf so, please givedetails below.What resources will you require? (e.g. questionnaires, equipme_nll {"1 example video Gamera,-*--:-r:-- r ^-3u-'^--. :' --"--r:----i-:5 61e io be used please give full details here).3 p; iAtiS!.tj lwl rrrcrr c; r I | \.1 lllrit rlvl I I lqll (

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    hoiyouintendtoaddresseachofthefollowinginyouretudy}.ConsentDebriefing

    \Mthdrawal from the investigationConfidentiali$Protection of participantsObservation research [complete if applicable]Giving advice

    cbarancefromanyotherbody/organisation?YeslNo(please circle as appropriate)lf Yes - please give details below.

    uesiofmyknowledgeandbelief,accurate'lclearlyunderstandmyobligations and the iignts of the participants. I agree to act at all times in accordance with University ofDerby Ethical Policy for conducting research with human participants.hala af a.rhmiaaian

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    Therapeutlc Arts & Gomplementary MedicineFaculty of Education, Health and Sciences

    ,-i, .',.:1,'- f;:-!ai:1qT :t +:-.:l 'rr.:'lr!l r!:i: .'1,1i'LiCATIOl'l THE FOLLOWING DOCUMENTATIONv.uncxn Hi;'ijRilPxiHT E rprease llcK ro inciicate the material that has been included or provide informationaS ii.i VtiiV ri r:S iia)i ;iV;ii.lirie IComments:

    Queetionnaires/lnterview sched ules: nCovering lettersllnformation sheets : nBriefing and dEbriefing material: nConsent forms for participante: trllA learning contract (lf applicable): n