Genetic Research Ethics Review Application

1. Project Information

Project Title Principal Investigator(s) Institution/Affiliation Email Address Phone Number Co-Investigators Funding Source

2. Project Overview

Background and Rationale Objectives Research Questions/Hypotheses Study Design & Methods Duration of Study

3. Participants

Population & Recruitment Inclusion Criteria Exclusion Criteria Estimated Number of Participants

4. Sample Collection & Handling

Type of Genetic Material (e.g., blood, saliva) Collection Procedure Sample Storage & Security Will samples be shared with other researchers? Yes No

5. Ethical Considerations

Consent Process Anonymization/De-identification Procedures Potential Risks to Participants Benefit to Participants/Community Dissemination of Results I confirm that all personal health information is protected in accordance with applicable privacy laws.

6. Additional Information

List Attachments (consent forms, questionnaires, etc.) Other Relevant Details