Vulnerable Populations Ethics Review Form

Project Information

Project Title Principal Investigator Email Date

Study Description

Brief Description of the Study Purpose and Objectives

Vulnerable Population Details

Specify the Vulnerable Population(s) Involved Justification for Inclusion of Vulnerable Group(s) Describe Additional Risks or Concerns

Consent and Safeguards

Describe Consent Process Measures to Protect Participants

Confidentiality and Data Handling

How will Data Confidentiality be Maintained? Who Will Have Access to the Data? Data Storage and Retention

Additional Comments