Medical Research Ethics Proposal Form
1. Project Information
Project Title
Date
Project Summary
2. Principal Investigator
Name
Email
Affiliation
Phone
3. Co-Investigators / Research Team
Names, Roles, and Affiliations
4. Study Details
Objectives
Research Design and Methods
Description of Study Population
Recruitment Procedures
5. Informed Consent
Description of Consent Process
6. Risks and Benefits
Potential Risks to Participants
Potential Benefits to Participants and Society
7. Confidentiality and Data Management
How will confidentiality be maintained?
Data Storage and Security Procedures
8. Funding and Conflicts of Interest
Funding Source(s)
Potential Conflicts of Interest