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UREC-Form-9-Application For Ethics Review of New Protocol

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UREC-Form-9-Application For Ethics Review of New Protocol

essay

Uploaded by

joyg1907
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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PUP-UNIVERSITY RESEARCH ETHICS CENTER

UREC Form No. 9


APPLICATION FOR ETHICS REVIEW OF A Version No. 1
NEW PROTOCOL

Instructions to the Researcher: Please accomplish this form and ensure that you have included in
your submission the documents that you checked in Section 2 (Checklist of Documents).

1. General Information
Technical Analysis of an Integrated Savonius and H-rotor Small Scale
Title of Study Vertical Axis Wind Turbine for Harnessing Power from Natural and
Vehicle-Generated Winds in North Luzon Expressway

UREC Study Site Polytechnic University


Code/REC of the
Panel Code Philippines – College
(To be provided of Engineering
by UREC/REC)
Name of Diana Mitchie S. Balte Contact Tel No: N/A
Researcher Information
Name of Co- Clarence Joyce B. Acuña, Mobile No:
researcher/s (if Nicole C. De Leon, 09569468601
any) Shella Marie Andrea L. Email:
Gomez, [email protected]

Jan Loren G. Tugay

Institution/ Polytechnic University of the Philippines / College of Engineering /


College/ Department of Electrical Engineering
Department
Address of PUP College of Engineering CEA Building, NDC Campus Anonas cor.
Institution Pureza Street, Sta. Mesa Manila, Philippines

Field of Study Education


(Please check Computer Science, Information Systems, and Technology
one) Engineering, Architecture, and Design
Humanities, Language, and Communication
Business
Social Sciences
Science, Mathematics, and Statistics

Source of Self-funded
Funding Government-funded
(Please check Scholarship/Research Grant
one) Institution-funded
Sponsored by a Pharmaceutical Company
Others

Duration of the Start Date: End Date: No. of Participants:


Study:

S423, 4th Floor South Wing, PUP A. Mabini Campus, Anonas Street, Sta. Mesa, Manila 1016
Trunk Line: 335-1787 or 335-1777 local 235/357
Website: www.pup.edu.ph | Email: [email protected]

THE COUNTRY’S 1st POLYTECHNICU


PUP-UNIVERSITY RESEARCH ETHICS CENTER
UREC Form No. 9
APPLICATION FOR ETHICS REVIEW OF A Version No. 1
NEW PROTOCOL

2. Checklist of Documents
Basic Study Protocol Supplementary Co-authorship
Requirements: Requirements: Agreement (For
multiple Authorship)
Informed Consent Form Notice to
English version Proceed/ Ethical
Filipino Version Clearance (For
external researchers
or Non-PUPian)
Assent Form (If applicable) Others (Please
English version specify)
Filipino Version
Research
Questionnaire

To be filled out by the applicant To be filled out by the Immediate


Supervisor
Accomplished by: Endorsed by:
As the researcher of this study, I hereby As the Research Adviser/Program Chair/
confirm that the information stated above is Dean, I hereby confirm that I have read
true. I understand that my study protocol shall this application and confirm to supervise
be reviewed by the UREC/REC, and I shall the conduct of this study. Further, I
abide by the rules and regulations set forth by confirm that the ethical standards set by
the Polytechnic University of the Philippines. the University shall be followed.

Signature over Printed Signature over


Date Name of Researcher Date Printed Name of the
Immediate Supervisor
To be filled out by the UREC

Completeness Complete Remarks:


of Document Incomplete

Received by:

Date Received:

Approved for Ethical Review

Date Research Management Office - University Research Ethics Center

S423, 4th Floor South Wing, PUP A. Mabini Campus, Anonas Street, Sta. Mesa, Manila 1016
Trunk Line: 335-1787 or 335-1777 local 235/357
Website: www.pup.edu.ph | Email: [email protected]

THE COUNTRY’S 1st POLYTECHNICU

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