Biomedical Research Ethics Application Form
1. Project Information
Project Title
Principal Investigator
Institution/Organization
Co-Investigator(s)
Contact Email
Contact Phone Number
Project Start Date
Expected End Date
2. Project Summary
Provide a brief summary of the research project
3. Objectives & Hypothesis
Main Objectives
Hypothesis/Research Questions
4. Methodology
Describe the study design and methodology
Study Site(s)
5. Study Participants
Number of Participants
Inclusion Criteria
Exclusion Criteria
Recruitment Method
6. Informed Consent
Process for obtaining informed consent
7. Data Management & Confidentiality
Describe how data will be collected, stored, and protected
Who will have access to the data?
8. Potential Risks & Benefits
Potential Risks to Participants
Potential Benefits to Participants and/or Society
9. Funding & Conflicts of Interest
Funding Source(s)
Declare any potential conflicts of interest
10. Declarations
I declare that the information provided is accurate and complete. I understand my responsibilities regarding research ethics.
Name
Date