Human Subjects Research Ethics Approval Application

1. Applicant Information

Principal Investigator Name Department / Affiliation Contact Email Contact Phone

---

2. Project Information

Project Title Funding Source (if any) Proposed Start and End Dates Brief Project Summary / Abstract

---

3. Research Participants

Describe participant population Recruitment methods Inclusion/exclusion criteria Estimated number of participants

---

4. Study Procedures

Describe study procedures and data to be collected Location(s) where research will be conducted Estimated time commitment per participant

---

5. Risks and Benefits

Potential risks to participants Risk mitigation strategies Expected benefits

---

6. Privacy and Confidentiality

How will data privacy/confidentiality be protected? Will data contain personally identifiable information? Yes No Data storage and retention plans

---

7. Informed Consent

Describe consent process Will minors (<18) or vulnerable groups be involved? Yes No

---

8. Additional Notes or Attachments

Additional Information