Standard Application Form For The Ethical Review Of Health-Related Research Studies, Which Are Not Clinical Trials Of Medicinal Products For Human Use As Defined In S.i. 190/2004 Page 4

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Version 5.5
May 2011
Office Use:
-
REC Reference No:__________
A5. Lead contact person who is to receive correspondence in relation
to this application or be contacted with queries about this application.
Title:
Dr. / Ms. / Mr. /
Prof.
Name:
Address:
Tel (work):
Tel (mob.):
E-mail:
A6. Please provide a lay description of the study.
Answer
A7 (a) Is this study being undertaken as part of an academic
qualification?
Yes / No
A7 (b) If yes, please complete the following:
Student Name:
Course:
Institution:
Academic Supervisor:
SECTION B
STUDY DESCRIPTORS
SECTION B IS MANDATORY
B1. Provide information on the study background.
Answer
B2.
List the study aims and objectives.
Answer
B3.
List the study endpoints (if applicable).
Answer
B4. Provide information on the study design.
Answer
B5. Provide information on the study methodology.
Answer
B6. What is the anticipated start date of this study?
Answer
B7. What is the anticipated duration of this study?
Answer
4 |
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