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WEST VISAYAS STATE UNIVERSITY

UNIFIED RESEARCH ETHICS REVIEW COMMITTEE


La Paz, Iloilo City 5000 Philippines
Tel No. +63 (033) 330-91 02

FORM 3.6 REQUEST/ QUERY RECORD

Date Received Received By

Request From Telephone call Number

Fax Number

Mailed letter / Date

E-mail / Date

Walk-in/Date/Time

Others (specify)

Name

Address Contact Number

Title of the Participating  EPI amid COVID-19: The Quality of Routine Vaccinations among Infants in
Study Iloilo Province from the Perspectives of their Mothers

Starting Date of
Participation

Request

Action Taken

Outcome

Form 3.6 Rev.:002


11/12/2019

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