Clinical Trial Ethics Approval Application Form

1. Study Information

Study Title Protocol Number Principal Investigator Name Institution / Organization Contact Email Contact Phone

2. Study Overview

Study Objectives Study Design Study Duration Study Location(s)

3. Participants

Target Population Estimated Number of Participants Inclusion Criteria Exclusion Criteria

4. Ethical Considerations

Potential Risks Potential Benefits Informed Consent Process Confidentiality Measures

5. Additional Documentation

Attach Study Protocol Attach Informed Consent Form Attach Other Supporting Documents

6. Declarations

I confirm that the information provided is accurate and complete. I agree to comply with relevant regulatory and ethical guidelines.