Biomedical Research Ethics Application

1. Project Information

Project Title Principal Investigator Name Institution/Department Email Phone

2. Study Summary

Background and Rationale Objectives Study Design/Methods

3. Participant Information

Participant Population Estimated Sample Size Inclusion Criteria Exclusion Criteria

4. Consent Process

How will consent be obtained?

5. Risks and Benefits

Potential Risks Potential Benefits

6. Data Management

Data Collection and Storage Confidentiality Measures

7. Funding and Conflicts of Interest

Funding Source(s) Conflicts of Interest (if any)

8. Declarations

I declare that the information provided is accurate and complete to the best of my knowledge. Yes No