Human Subjects Ethics Review Application
1. Project Information
Project Title
Principal Investigator
Department/Faculty
Email
Co-Investigators (if any)
Project Start Date
Project End Date
2. Project Summary
Brief Description of the Study
Objectives
Rationale and Significance
3. Participants
Description of Participant Population
Estimated Number of Participants
Age Range
Inclusion Criteria
Exclusion Criteria
Recruitment Methods
4. Consent Process
How will informed consent be obtained?
Attach Participant Information/Consent Forms
5. Procedures
Describe all research procedures involving participants
Duration for Each Participant
6. Data Handling and Confidentiality
Describe How Data Will Be Stored and Protected
Who Will Have Access to the Data?
How Long Will Data Be Retained?
How Will Anonymity or Confidentiality Be Maintained?
7. Potential Risks and Benefits
Describe Any Potential Risks to Participants
Describe Any Potential Benefits
How Will Risks Be Minimized?
8. Additional Documents
Attach Recruitment Materials
Attach Survey/Interview Instruments
9. Declarations
Principal Investigator Name
Date
Signature