Committee:--Select Committee--Scientific Review Committee Institutional Ethics CommitteeCategory :--Select Category--FacultyStudent UGPG CRRIStudy Title:Project Duration (in months):Research Type: -- Select Research Type--Clinical ResearchEpidemiologyBasic ScienceResearch and Product DevelopmentRetrospective studyCase series / Case ReportsStudent NameDesignation DepartmentEmail * PhoneGuide Name Designation Department Email *PhonePrincipal investigator:DesignationDepartmentEmail *PhoneCo-investigator NameDesignationEmail * PhoneOther Co-investigator details:Funding agencies:SelfSponsorName of the sponsorBudget (Rs):Study location:Area of study:Introduction:Not lessthen 250 words-Max 500 wordsAim:Objective:MethodologyInclusion criteria:Exclusion criteria:Sample sizeDetailed ProcedureExpected outcome:Risk & BenefitsRemarks:Reference:Ethical Points 1. Will this study involve materials that may be hazardous to the human subjects? YesNo2. Will this study involve human tissue or body fluids as a subject of research?YesNo3. Will this study involve pregnant woman as research subjects?YesNo4. Will this study include subjects who have cognitive impairment that interferes with the ability to give informed consent?YesNo5.Will the subjects be paid?YesNo6. Will there be additional charges to patients to participate in the study?YesNo7.Are you sharing data with other institutes/company?YesNo8. Does this project involves sending any biological samples to other institutes/company?YesNo9. Any standard precautions to be followed for the project? YesNo10. Does the proposal adhere to good Laboratory / Clinical Practices? YesNo11. Is the Project Economically Relevant / Chance for Patents ?YesNo12. Does the project involve process development?YesNo13. Does the Project Involve Multiple Institutes YesNo14. Does the Project Involve Organ Transplantation? YesNo15. Any other additional commentsFile AttachmentBilingual concern form (PDF only)Max File Size 5MBProforma (PDF only)Max File Size 5MBQuestionnaire (PDF only)Max File Size 5MBPPT fileMax File Size 5MBAdditional files (if any) (PDF only)Max File Size 5MBCover letterMax File Size 5MBDean approval letter for hospital data/sample utilizationMax File Size 5MBPhoneSubmit
