Ethics Form

Use the text box size as a guide; however, you can type beyond what is visible.

Last name

First name

CASE 1

a. 1st of 2 most relevant principles (explain briefly)

2nd of 2 most relevant principles(explain briefly)

b. Least relevant principle (explain briefly)

c. On a scale from 1 (low) to 10 (high), rate (enter number in box to the left of each)

1. The potential benefits from the study

2. The costs or risks to the participants

CASE 2

a. Would you approve it?

Yes

Why or why not?

b. Additional safeguards?

c. On a scale from 1 (low) to 10 (high), rate

1. The potential benefits from the study

2. The costs or risks to the participants

CASE 3

a. Whose permission, if any?

b. Information to be released?

c. Safeguards?

d. Publication conditions, if any?

e. On a scale from 1 (low) to 10 (high), rate

1. The potential benefits from the study

2. The costs or risks to the participants

Additional comments?
(not required)