Community-Based Participatory Research Ethics Approval Request Form

Project Information

Project Title Principal Investigator(s) Contact Email Institution / Organization Community Partner(s) Proposed Start Date Proposed End Date

Project Description

Brief Summary of the Project Research Objectives Describe the Research Methodology

Community Involvement

Describe the Role of Community Partners How will community members participate in project design, data collection, and dissemination?

Ethical Considerations

Describe informed consent process Describe risk/benefit assessment How will confidentiality and privacy be ensured? Plans for dissemination and sharing results with the community

Documentation

List documents attached (e.g. consent forms, questionnaires, MoUs)