Swinburne Neuroimaging EEG & TMS Project Application

Swinburne Neuroimaging (SNI) strongly recommends that you meet with the relevant SNI team members to discuss your project before completing this application form.

We support research stages from project conception, design, and logistical planning, to optimal data acquisition, analysis and computing. SNI can also offer advice on research ethics and data management. Seeking our advice early in the process will streamline your access to our facilities. 

To organise a meeting to discuss your project with SNI please contact us at neuroimaging@swin.edu.au.

Did you consult with SNI staff before beginning this application? *

YesNo

Documents

Original ethics application *

Evidence of ethics approvals *

Evidence of amendment/s to the ethics application (and approvals)

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If any amendments have been made to the original ethics application, you must submit evidence of these changes and associated ethics approvals

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Participant Information and Consent Form/s indicating how incidental findings will be managed  *

×  

These must be aligned with Swinburne Neuroimaging's policy and refer to the relevant SNI Pre-Scan Information Forms

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Study protocol information *

Funding information

Once you have these documents ready, please proceed to the next page.

Date of application *

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Applicant Details

Title *Dr.Mr.Mrs.Ms.Mx.A/Prof.Prof.Prefer not to answer

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First Name *

Last Name *

Affiliation *

Position *

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Street Address *

City *

State *

Country *

Post Code *

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Email Address *

Contact Number *

Chief Investigator

Is the Applicant also the Chief Investigator (CI) of this project? *

YesNo

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Chief Investigator Details

Title *Dr.Mr.Mrs.Ms.Mx.A/Prof.Prof.Prefer not to answer

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First Name *

Last Name *

Affiliation *

Position *

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Street Address *

City *

State *

Country *

Post Code *

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Email Address *

Contact Number *

Associate Investigators

How many Associate Investigators are on this project? *01234567891011+

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Name *

Position *

Affiliation *

Access to scanner/s required? *

YesNo

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Name *

Position *

Affiliation *

Access to scanner/s required? *

YesNo

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Name *

Position *

Affiliation *

Access to scanner/s required? *

YesNo

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Name *

Position *

Affiliation *

Access to scanner/s required? *

YesNo

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Name *

Position *

Affiliation *

Access to scanner/s required? *

YesNo

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Name *

Position *

Affiliation *

Access to scanner/s required? *

YesNo

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Name *

Position *

Affiliation *

Access to scanner/s required? *

YesNo

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Name *

Position *

Affiliation *

Access to scanner/s required? *

YesNo

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Name *

Position *

Affiliation *

Access to scanner/s required? *

YesNo

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Name *

Position *

Affiliation *

Access to scanner/s required? *

YesNo

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Additional Associate Investigators *Please list the name, position and affiliation of any additional Associate Investigators, and indicate whether they will require access to the scanner/s.

Project Details

Have you already used our facilities for this project? *

YesNo

Type of Research *AppliedBasicClinical TrialInformatics Only

Research Project Title *

What are the aims/objectives of the project? *

What is the total number of participants for your project? *

What age range are your participants? *

Please describe your participant group/s (including the total number of participants per group) *

Does your project involve any of the following participant groups? *

Elderly > 65 yearsChildren < 18 yearsNone of the above

Are any of your participant groups considered vulnerable? (e.g., mental illness) *

YesNo

Does your project include medical and/or psychological support? *

YesNo

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Name of Medical Officer

Name of Psychologist

Are there any special requirements for the imaging sessions?

Funding Details

If no funding information is available at this time, please write N/A in all funding detail response boxes

Please provide your grant/funding information *If funding information is not available, please write N/A

Is your funding administered via SUT? (do you have a SUT project account number?) *

YesNoN/A

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Please provide your project account details

Project number *

Research Coordinator Name *

Research Coordinator Email *

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Please provide your organisation's details for invoicing purposes

ABN *

Finance Officer / Account Payable in charge of account *

Contact Number *

Email *

SNI Facilities

Please select all that are applicable to your project *

EEG Laboratory UseEEG Remote Equipment - ANT SystemTMS (BSP: Brain Stimulation and Psychophysiology Lab)

Please indicate how long you are requesting to loan the EEG equipment for *

Please indicate how long you are requesting to loan the TMS equipment for *

Please select all that apply *

ANT AmplifierANT Amplifier to Computer AdapterANT Battery BoxANT Power AdapterASA Lab DongleASA Lab Software Install CDComputer Connection Cable (ANT)EEG Cap: Waveguard 64 ChannelNone of the above

Please indicate how long you are requesting to loan the ANT equipment for *

Please describe what you plan to use the equipment for *

Is there any other equipment you would like to use with the requested modality? *

NonePsychophysiology Equipment (BSP Lab)Other

Please specify what other equipment you need *

Are there any other facilities you would like to use for this project? *

NoneEEG (in our separate EEG labs)Interview room (outside of MRI/MEG)Psychophysiology equipment (BSP lab)Other

Please specify *

Scheduling Details

Anticipated start date of lab use/equipment loan *

Anticipated finish date of lab use/equipment loan *

Will participants have repeated EEG or TMS (e.g., as part of a longitudinal or treatment study)? *

YesNo

Please decribe the number of EGG/TMS sessions per participant and the duration between sessions *

Please use this space to add any additional detail about your research project that you consider necessary

How did you hear about SNI?

Please tell us how you first heard about SNI? *

Please tell us who your contact/s have been at SNI? *

Checklist of Attachments

Before you are granted access to our facilities or equipment we must receive the following documentation for your project

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Study protocol

Your study protocol must specify: 

1. number and type of participants (e.g., controls and/or details of clinical groups)

2. experimental design, and task paradigm to be examined

3. any ancillary equipment to be used

Upload Study Protocol *

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If you do not yet have a study protocol please provide as much information as possible.

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Study Participant Information and Consent Form/s

Your Participant Information and Consent Form/s must refer to the SNI MRI and/or MEG Pre-Scan Information and Safety Questionnaire and Consent form/s. Please upload a maximum of 4 files

Upload Participant Information and Consent Form/s *

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Evidence of Ethics Approvals

Please upload your original ethics application and ethics approval letters (with approval dates and reference number). 

Upload Ethics Application *

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Upload Ethics Approval *

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Have you made any amendments to the original ethics application? *

YesNo

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Ethics Amendments

Please upload any ethics amendments and a letter of approval of any ethics amendments.

Upload Ethics Amendment Application

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Upload Ethics Amendment Approval

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Please note: If the ethics application of your host institute lists a Swinburne University researcher, you will have to apply for expedited ethics review with Swinburne’s Human Research Ethics Committee (SUHREC). This process is explained here: https://www.swinburne.edu.au/research/ethics/human-research/how-to-apply-for-ethical-review/ 

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