SayPro Social Impact Assessments Office

Ethical Approval Form

Project Title:

[Enter the title of your project]

Principal Investigator(s):

Name(s), Position(s), Department(s), Contact Information

Project Summary:

Provide a brief summary of the project including objectives, methodology, and anticipated outcomes.

Purpose of the Study:

Explain the reason for conducting the study and its significance.

Study Population:

Describe the participants (e.g., demographics, number, recruitment methods).

Procedures:

Outline the methods and procedures that will be used in the study.

Potential Risks:

Identify any potential physical, psychological, social, or legal risks to participants.

Benefits:

Describe any benefits to participants or society from the study.

Confidentiality:

Explain how participant information and data will be kept confidential and secure.

Informed Consent:

Describe the process for obtaining informed consent from participants. Attach consent forms.

Data Storage and Retention:

Explain how and where data will be stored, how long it will be kept, and who will have access.

Conflict of Interest:

Disclose any potential conflicts of interest.

Funding Source(s):

Provide details of funding support, if any.

Ethical Considerations:

Describe how ethical issues will be addressed, including respect for participants’ rights and cultural sensitivities.

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Declaration by Investigator(s):

I certify that the information provided is accurate, that the research will be conducted in accordance with ethical principles, and that all applicable policies and guidelines will be followed.

Signature: _____________________
Date: _____________________

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Office Use Only:

Date Received:
Application Number:
Review Outcome (Approved / Modifications Required / Rejected):
Comments:
Signature of Ethics Committee Chair:
Date: