1. Project & Investigator Information
Project Title
Principal Investigator Name
Department / School / Affiliation
Email Address
Phone Number
Other Investigators (if any)
Funding Source (if any)
2. Project Overview
Abstract / Purpose of the Study
Research Questions / Hypotheses
Study Dates
3. Participants
Population / Sample Description
Number of Participants
Participant Recruitment Procedures
Age Range
Vulnerable Populations Involved?
None
Children
Prisoners
Pregnant Women
Other
4. Research Procedures
Description of Data Collection Methods (e.g., survey, interview, focus group)
Location of Study (in-person, online, both, specify locations)
Estimated Time Demand per Participant
5. Risks & Benefits
Potential Risks to Participants
Potential Benefits
Risk Minimization Strategies
6. Privacy & Confidentiality
How will you maintain confidentiality/anonymity?
Data Storage and Security Measures
Who will have access to the data?
7. Consent Process
Describe Consent Process
Attach Consent Form?
8. Additional Information
Conflicts of Interest (if any)
Other Relevant Information