Retrospective Data Study Ethical Approval Application Form
1. Study Title
2. Principal Investigator
Full Name
Affiliation
Email
Phone
3. Study Team Members
List names, roles, and affiliations
4. Study Objectives
5. Data Source
Describe the data source and custodian
6. Data Description
Type of data, period covered, and amount
7. Data Privacy & Confidentiality
Describe how data privacy/confidentiality will be protected
8. Ethical Issues
Explain potential ethical issues and how they will be managed
9. Data Access
Who will have access to the data?
10. Data Storage & Security
Describe storage, security measures, and retention period
11. Results Dissemination
How and where will the results be disseminated?
12. Other Ethics Approvals
Has the study obtained/been submitted for other ethics approval?
13. Declaration
I confirm that the information provided is accurate.