Community-Based Research Ethical Approval Application Form

1. Project Information

Project Title Project Summary

2. Principal Investigator

Name Affiliation Email Phone

3. Community Partners

Names and Affiliations

4. Project Details

Objectives Methodology Timeline

5. Community Involvement

Role of Community in Research

6. Ethical Considerations

Potential Risks Potential Benefits Confidentiality Measures

7. Informed Consent

Describe Informed Consent Process

8. Additional Information

Additional Comments

9. Declaration

Applicant Name Date