Public Health Research Ethics Application
1. Applicant Information
Principal Investigator Name:
Affiliation/Institution:
Email:
Contact Number:
2. Project Details
Project Title:
Co-Investigators (List):
Project Duration (Start - End Date):
Funding Source (if any):
3. Research Summary
Background & Rationale:
Objectives:
Methodology:
Participant Criteria (Inclusion/Exclusion):
4. Ethical Considerations
Potential Risks to Participants:
Potential Benefits:
Informed Consent Process:
Privacy & Confidentiality Measures:
Protection of Vulnerable Groups (if applicable):
5. Data Management
Type of Data Collected:
Data Storage & Security:
Who Will Have Access to Data:
Plans for Data Sharing/Publications:
6. Additional Information
Has this protocol been reviewed elsewhere? If so, provide details:
Other Relevant Information: