Swinburne Neuroimaging (SNI) 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  *

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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

Please provide your grant/funding information *

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

YesNo

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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 *

MEG3T MRIInformatics

Please estimate the duration of each MEG scan (from the time you enter the facility until you leave the facility) *

Please estimate the duration of each MRI scan (from the time you enter the facility until you leave the facility) *

MRI *

Structural MRI only (30 minutes booking required)Multiple MRI sequencesDiffusion MRI

Please describe *

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

NoneEEG equipmentEye-trackingOther

Please specify *

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)TMS (Brain Stimulation and Psychophysiology (BSP) lab)Psychophysiology equipment (BSP lab)Other

Please specify *

Scheduling Details

Anticipated scanning start date *

Anticipated scanning end date *

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

YesNo

Please decribe the number of scans per participant and the duration between scans *

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

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NIF/NCRIS Acknowledgement

All projects utilising Swinburne Neuroimaging (SNI) facilities must acknowledge our funders (the National Imaging Facility/ National Collaborative Research Infrastructure Strategy) in all publications/presentations arising from use of the SNI Facility. For further information, please contact  neuroimaging@swin.edu.au.

Please sign below as evidence of your agreement with this condition *

Clear

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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

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. MRI sequences to be used

4. 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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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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