Public Health Research Ethics Approval Application

1. Project Details

Project Title Principal Investigator Affiliation / Institution Contact Email Co-Investigators

2. Summary

Project Summary Objectives

3. Methods

Study Design Participants / Population Recruitment Methods Data Collection Methods

4. Risks and Benefits

Potential Risks to Participants Potential Benefits to Participants / Society

5. Informed Consent

Consent Procedures How will confidentiality be ensured?

6. Data Management

Data Storage and Security Data Access and Sharing

7. Ethical Considerations

Additional Ethical Issues

8. Declarations

Has this proposal been submitted elsewhere? Yes No Signature (Type Name) Date