Genetic Research Ethics Approval Request Form

1. Project Information

Title of Project Principal Investigator Name Department / Institution Contact Email Contact Phone Co-investigators / Collaborators

2. Project Description

Brief Summary of Research Objectives Scientific Background & Rationale

3. Genetic Material

Source(s) of Genetic Material Type of Genetic Material Collection, Storage, and Management Details

4. Participant Information

Population (e.g., number, characteristics) Recruitment Method Inclusion/Exclusion Criteria

5. Consent Process

Describe Informed Consent Procedure Will participants be able to withdraw consent? Yes No

6. Privacy & Confidentiality

Describe data protection measures and anonymization process

7. Potential Risks and Benefits

Potential Risks to Participants Potential Benefits to Participants / Society

8. Data Sharing and Results Dissemination

Will genetic data/material be shared? Yes No If yes, specify with whom and under what conditions Plans for dissemination of results

9. Additional Information

Date Principal Investigator Signature