Community-Based Research Ethics Application

1. Project Overview

Project Title Lead Researcher(s) Affiliation(s) Community Partner(s) Contact Email Project Start Date Project End Date

2. Project Description

Brief Summary of the Project Research Objectives

3. Community Involvement

Describe Community Participation and Roles Describe How Community Input Has Shaped The Project

4. Participants

Describe Participant Recruitment Inclusion and Exclusion Criteria

5. Ethics & Consent

Consent Process Risks and Benefits to Participants/Community Data Confidentiality and Security Measures

6. Data Management

Describe Data Collection Methods Describe Data Storage, Access, and Disposal

7. Knowledge Sharing & Results

How will results be shared with the community? Plans for Publication or Dissemination

8. Signatures