DATE: PROJECT TITLE: PRINCIPAL INVESTIGATOR:

RATIONALE FOR PROPOSED RESEARCH A. PROPOSED RESEARCH RATIONALE

What is the rationale for the proposed research? What are you trying accomplish and how will this research accomplish your aims?

B.

SPECIFIC PROCEDURES TO BE FOLLOWED

What procedures will you follow for this research? How will you go about conducting the research on subjects?

C.

RECRUITMENT OF SUBJECTS AND OBTAINING INFORMED CONSENT

Where will you find the subjects for your research? How will you ensure an accurate and effective population sample? How will you obtain informed consent?

D.

CONFIDENTIALITY
How will you maintain the confidentiality of participants in your research? How will you ensure the confidentiality of all documents?

E. F. G. H.

POTENTIAL RISKS TO SUBJECTS

What are the potential risks to subjects in your study?

BENEFITS TO BE GAINED BY THE INDIVIDUAL AND/OR SOCIETY

What are the benefits that will be gained from this study?

INVESTIGATORS EVALUATION OF THE RISK-BENEFIT RATIO

Do the benefits outweigh the risks or not? Explain.

SUPPORTING DOCUMENTS

ist any supporting documents !such as the actual research instruments and any consent forms".