Clinical Trial Research Ethics Approval Request Form
1. Study Information
Title of Study
Protocol Number
Date of Submission
Study Summary
2. Principal Investigator (PI) Details
Name
Affiliation
Email
Phone
3. Co-Investigators
Names and Affiliations
4. Study Site(s)
Name(s) and Location(s)
5. Funding Source
Source of Funding
6. Ethical Considerations
Potential Risks to Participants
Potential Benefits to Participants
Informed Consent Procedures
7. Additional Comments
Comments