Scientific research licence application - Health Related Research

Planned dates for research activities in the current calendar year:

*Please advise NRI immediately if you need to change your research field dates in the current year.

If Yes, please provide the anticipated completion date (month/year) for the multiyear research.

Multiyear Project Completion Date :

*You must submit a full application to renew a multiyear license if there are changes to your research locations or to your study design. Multiyear research licenses may be renewed for two consecutive years without a full new application.

Please attach a non-technical description of the project proposal, no more than 500 words, in English and Inuktitut (+Inuinnaqtun, if in the Kitikmeot). The project description should outline the following:

• Project Title
• Lead Researcher’s Name and Affiliation
• What research questions does the project hope to answer?
• What are the research objectives and why is the study needed?
• Where, when, and for how long will the field research be undertaken?
• What methods will be used to conduct fieldwork?
• What impacts will the research produce to the environment, wildlife, or people?
• How will the data generated by the research be stored and managed?
• How will Nunavut residents be involved in the research? and
• How, when, and to whom will the research results be shared in Nunavut?

Please attach a full project protocol detailing the following information:

Overall Program

• Rationale, goals & objectives for the project
• Will the research be undertaken in conjunction with or in support of any current health initiatives in Nunavut? If so, reference the programs and explain the relationship.
• Explain the role of Nunavut’s Department of Health (DOH) in the research and describe any support you will required from DOH staff or facilities to conduct the research
• Identify the primary sources of funding for the research project

Methodology

• Techniques and protocols for sample collection and analysis
• Justification for the selection of the study methodology
• If interviewing the participant is required, provide a list of questions to be posed
• Location of research and rationale for selecting specific communities or individuals for your research

Primary data and information

• Short & long term use of data
• Accessibility to data
• Short & long term storage of data
• Disposal of data
• Other uses of data (will data be shared with other researchers for research purposes unrelated to the current project?)
• Intellectual property rights/ownership of data

Biological Samples

• Type and amount of biological materials to be taken
• Manner in which biological materials will be taken, and the safety and invasiveness of the procedures for acquisition
• Intended uses of the biological materials, including any commercial use (Note: a separate research license is required for secondary use of human biological materials originally collected for a purpose other than the current research purpose);
• Measures employed to protect the privacy of and minimize risks to participants
• Length of time the biological materials will be kept, how they will be preserved, location of storage (e.g., in Canada, outside Canada), and process for disposal, if applicable
• Anticipated linkage of biological materials with information about the participant

Medical chart reviews

• Request for a waiver of consent to use personal medical information that was collected for purposes other than the current research. (Note: refer to the guidance document: Health Research in Nunavut: Special Considerations for Remote Data Collection)

Please attach a copy of the actual consent form that will be used during the proposed study.  Consent forms must be in English and Inuktitut (+Inuinnaqtun, if in the Kitikmeot). Components of the participant consent form must include:

• Project title
• The principal investigator’s name, address, e-mail address, and phone number
• A description of the research being conducted, including the purpose, objectives, aims of the study at a reading comprehension level that is appropriate for the participant
• A description of the activities/tasks that the participant will complete for the research, and an estimated time commitment for taking part, at a reading comprehension level that is appropriate for the participant
• A clear description of any potential risks that may be associated taking part in the research
• Details of any financial remuneration, incentive or other compensation to be provided to the participant for taking part in the research
• A statement of informant rights:
  I have been fully informed of the objectives of the project being conducted. I understand these objectives and consent to being interviewed for the project. I understand that steps will be undertaken to ensure that this interview will remain confidential unless I consent to being identified. I also understand that, if I wish to withdraw from the study, I may do so without any repercussions.
• Details on the type of data that will be collected from the participant and how privacy and confidentiality will be maintained
• Conditions for release of recorded information
• Printed name of participant, signature of participant, date of consent

P.O. Box 1720 Iqaluit, NU, X0A 0H0 • PHONE: 867-979-7279 • FAX: 867-979-7109 • email mosha.cote@arcticcollege.ca