Please note that protocols which do not provide sufficient information for the Ethics Committee to make an adequate assessment may be returned for revision. Section 2: Checklist Please circle your response to each of the following questions: Does the research involve participation of Aboriginal or Six Nations people who have been selected as research participants because they are North American Indians? YES / NO Does the research involve any artifacts that are of cultural, spiritual or religious significance to Aboriginal or Six Nations people? YES / NO Does the research involve an unusually dependent relationship between the researcher and any of the research participants? YES / NO Could the research place research participants in an unusually vulnerable situation? YES / NO Is there any potential risk (physical, emotional, social or legal) to individual participants’ well being, beyond that normally encountered in everyday life, as a result of their involvement in the research? YES / NO Does the research involve the administration or application of drugs and/or Clinical Trial Notification Scheme (CTN) documentation? YES / NO Is there any reasonable likelihood that the research will result in the reporting of suspected child abuse? YES / NO Is there any potential risk to the researcher’s safety, beyond that normally encountered in everyday life, as a result of their involvement in the research? YES / NO Do you plan to vary the usual written consent processes? YES / NO Is the study known to involve research into illegal activities? YES / NO Does the study have potential legal implications for the researcher or the Six Nations Council? YES / NO Does the methodology of the research conform to the standards outlined in the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans? YES / NO Have you applied for funding for this research? YES / NO If YES, please list the names of funding/grant bodies applied to and the type of funding sought: _____________________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

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