Undergraduate Research Ethics Approval Request Form

Student Information

Full Name Student ID Email Program of Study Year Level 1st Year 2nd Year 3rd Year 4th Year Other

Supervisor Information

Supervisor Name Supervisor Email Department

Project Details

Project Title Project Summary Research Methods Participants (Who will participate? How will they be recruited?)

Ethical Considerations

Potential Risks to Participants Confidentiality Measures How will informed consent be obtained?

Additional Information

Additional Comments