Human Subject Research Ethics Approval Form

Applicant Information

Name Department/Institution Email Position/Title

Project Information

Project Title Project Summary Objectives Estimated Duration

Participants

Target Population Estimated Number of Participants Recruitment Method

Procedures

Methods & Procedures Data Collection Methods

Ethical Considerations

Risks and Discomforts Benefits Informed Consent Process Confidentiality Measures

Approval

Principal Investigator Signature Date Ethics Committee Decision Comments/Conditions