AF 03-07

Example
Application Form for an Ethics Review of Research Involving Human Subjects
1. Title of the research project (in Thai) …………………….
…………………………………………………………………………………………………………………………...

………………………………………………………………………………................................................................................................Title of
the research project (in English)
……………………………………………………………………………………………………………………………………………………………
…………………………………………………………………..................................................................................................

2. Name of the principal researcher………………………………………………………………………..………………….

Status (lecturer/researcher/student) ………………………………………………………………………..…………......
affiliated to Faculty/College/Institute ………………………………………………………………………..….………
Telephone number…………………………………………………… Fax…………………………………………………… Mobile
number…………………………………………………… e-mail……………………………………………………….
3. Do you have any conflict of interest/conflict with anyone?  No /  Yes please
specify…………………………………………………………………………………………………………
4. In addition to the research project that you have herein submitted for an ethics review of research
involving human subjects, are you engaged in any other research projects?
 No /  Yes please specify the number of projects you are engaged in ……………... projects.
5. Please indicate the research sampling population/participants.
5.1 A vulnerable/ deprived group
( ) Psychosis patients (such as depression) ( ) Gamblers/waiters in gambling houses
( ) Children under 18 years of age ( ) The physically disabled
( ) The elderly with memory deficiency ( ) Male/female sexual service persons
( ) Patients with dementia ( ) People of the alternative sex
( ) Waiters in night entertainment venues/ ( ) Pregnant women
massage parlours
( ) People with mental deficiency/ short ( ) Immigrants/displaced people/
attention span transnational labourers
( ) Patients with serious infectious diseases ( ) Conscripts
( ) Minority groups from different racial and/or ( ) Drug addicts
religious backgrounds
( ) Prison Inmates/the accused/defendants in criminal case
( ) Other………………………………………………………………

5.2 Those belonging to an invulnerable/a non-deprived group; namely,

……………………………………………………………………………………………………………………………………………….
……………………………………………………………………..............................................................................................

6. Number of places where the information will be collected ……....................................….. places;

please specify
7. Source of financial support for research (if any)
……………………………………………………………………....................................................................................................................................
.....................

Status of financial support

 AF 03-07

 In a review process
 Having been notified that the financial support is, in principle, granted
 An agreement on acceptance of the financial support has been signed. The number of grants
expected to be received/having been received……………………………………………........
The amount of money expected to be received/having been received in total ……….................
…………… Baht

8. Status of the research proposal/thesis proposal

 The research proposal has been reviewed/approved by the Office to which the researcher is
affiliated on Date……………./………….…./………..……
 The thesis proposal has been reviewed and approved by the Faculty/College/Institute
Administrative Board on Date……….…../.….......…../………..…

9. In cases of co-research, co-conducted by different offices/institutes, please specify their

names……………………………………………………………...………………………………………………..……..
10. Attachments

Researcher Official
List of Documents
Yes No Yes No
10.1 A letter accompanying the submission of a full research    
proposal/full thesis proposal for an ethics review for
research involving human subjects
10.2 An application form for an ethics review of research    
involving human subjects
10.3 Document Providing information for the research    
sampling population/participants
Notes: (1) The thesis proposal has to be signed by the thesis
advisor.
(2) If the research participants do not understand
Thai,
they must be provided with a document containing
information which has been translated into a local or
foreign language.

10.4 A letter of consent from the research sampling    

population/participants
Notes: (1) The thesis proposal has to be signed by the thesis
advisor.
(2) If the research participants do not understand
Thai,
they must be provided with a document containing
information which has been translated into a local or
foreign language.

10.5 The entire execution plan of the project; namely, the    

schedule of different periods of execution, all stages of
research activity, the estimated time for applying for an ethics
review for research involving human subjects
 AF 03-07

Researcher Official
List of Documents
Yes No Yes No
10.6 The researcher’s CV and experience to show his/her    
ability
to conduct this research
10.7 The full research proposal/thesis proposal printed on both    
sides of the page which covers the following:
10.7.1 The research project’s title in Thai and English    
10.7.2 The research rationale and research questions    
   
10.7.3 Literature review, objectives and the scope of the
research
   
10.7.4 Research procedure and the stages of research
execution(emphasizing the methods of random
sampling/selecting samples and the methods of
selecting information)
10.7.5 The research sampling population/participants and
   
the criteria for selecting the research participants
and removing them from the project and other
criteria    
10.7.6 Details on how to contact and gain access to the
research participants    
10.7.7 Methods for protecting the rights, preventing risk
and keeping confidential matters of the research    
sampling population/participants    
10.7.8 References
10.7.9 Estimated budget in different categories that the
researcher has received/will receive or from his/her    
personal funding
10.7.10 Research instruments; for example,
questionnaires,
test programmes, handbooks etc., which have
been
approved by the experts (Please specify)    
1. ……………………………………
2. ……………………………………
3. ……………………………………
10.7.11 Other documents; for instance, documents for
publicizing, brochures, leaflets etc. (Please
specify)
1. ……………………………………    
2. ……………………………………
3. ……………………………………

10.7.12 A CD containing the files of all the documents,

covering the Information from items 10.7.1 –
10.7.11

11. I, the researcher, am willing to comply with the conditions of the Committee in terms of what
follows:
 AF 03-07

11.1 I understand that it is unethical in research involving human subjects if a researcher

collects research information before the research proposal is approved or certified by the Research
Ethics Review Committee for Research Involving Human Subjects: The Second Allied Academic
Group, Chulalongkorn University.
11.2 If the certificate of the research project expires but the collection of information
in/with/from human subjects has not yet finished, the researcher must halt the collection process and
re-submit a request for approval. This must be done not less than one month or thirty days before the
expiry date, together with the submission of a research progress report. If the research still requires
the compilation of information results, the analysis of information and the writing of a report of the
research outcomes, the researcher does not have to reapply for the approval of ethics.
11.3 The researcher must conduct the research strictly in accordance with what is specified
in the full research proposal/thesis proposal.
11.4 The researcher must only use documents that provide information for the research
sampling population/participants, the letter of consent from the research sampling
population/participants and research instruments which have been endorsed with the seal of the
Committee.
11.5 In cases where seriously untoward incidents happen to the place where the information
approved by the Committee is kept, the researcher must report the incidents to the Committee within
five working days.
11.6 If there is any adjustment/change in the research procedure, the researcher must
submit a list of adjustments/changes to the Committee for approval/certification before continuing
with those adjustments/changes.
11.7 For the execution of a project of less than one year, the researcher must submit the
research termination (AF 03-13) and an abstract of the research outcome within thirty days/one
month of the research being completed. For a research project which is a thesis, the researcher must
submit an abstract of the research outcome within thirty days/one month of the research project being
completed and the thesis being submitted.
12. I wish to apply for a certificate of approval.
 In Thai (Write the name and surname in Thai)…………………………………………………….……
 In English (Write the name and surname in English)………………………………………………..

(……………………………………….) (…………………………………….)
Thesis advisor Principal researcher
…………/………../……..… …………/………../……..…

Application for an ethics review of research involving human subjects certified

(…………………………………….)
Dean/Director
………/………../……..…

Note: In cases where the research project is conducted by a lecturer/researcher, only the signature
of the main researcher is required and there is no need to have the application for ethics review of
research involving human subjects certified by the researcher’s superintendent.