Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 2

DMC COLLEGE FOUNDATION INC.

COLLEGE OF NURSING

Request for Approval

Name: __________________________________________ Protocol No. ________________________

Department: _____________________________________ Year and Section:__________________

Protocol Title:

__________________________________________________________________________________

__________________________________________________________________________________

Supporting information concerning the topic and the projected research (synopsis, consent, evaluation
etc.) is submitted on the attached pages(s). The topic will be investigated under the direction of the
following committee:
Name Email Department
Chair Dr. Ma Grace F. Gurdiel, MAN
Coordinato Maridol B. Claro, MN
r
Adviser Harold S. Nabor, USRN, MAN-car
Panel Mirasol R. Reyes, RN, LPT, MPA,
Member MAN-car
Panel John Del C. Yunting, LPT, MAEM
Member
Panel Faculty- College of Nursing
Member
==================================================================================

The proposed research does involve human research subjects & requires full committee review.

==================================================================================

Principal Investigator:

_________________________________________

Signature over Printed Name of the Student, Date

Endorsed by:

_____________________________

Signature over Printed Name and Date

Research Instructor

_____________________________

Signature over Printed Name and Date

Level Coordinator

Approved by:

Dr. Ma. Grace F. Gurdiel, MAN


Dean, College of Nursing

You might also like