REC Form No: 5A

Version No: 03
5A. Application for Ethics Review of a Approval Date: 06/15/2022
New Protocol
Effective Date: 08/15/2022

Instructions to the Researcher: Please accomplish this form and ensure that you have included
in your submission the documents that you checked below (in Section 3. Checklist of
Documents).

1. General Information

*Title of Level of Awareness and Performance of Boholano Folk Dances among the
Study Senior High School Students in Alicia Bohol

*REC Code
(To be
*Study Site
provided by
REC)
*Name of *Tel No:
Ma. Daisy A. Milana
Researcher *Mobile No: 09104808798
Contact
*Co- *Fax No:
Information
researcher (if *Email:
any) mdamilana@universityofbohol.edu.ph
*Institution University of Bohol
*Address of
Dr. Cecilio Putong Street, Cogon, Tagbilaran City, Bohol
Institution
*Type of Clinical Trial
Study (Sponsored) Biomedical research (Retrospective, Prospective
Clinical Trials and diagnostic studies)
(Researcher- Stem Cell Research
initiated) Genetic Research
Health Operations Others _____________________________
Research (Health
Programs and
Policies)
Social / Behavioral
Research
Public Health /
Epidemiologic
Research
Others
Content Analysis
 Multicenter Multicenter Single Site
(International) (National)
Self-funded Sponsored by a Pharmaceutical Company
Government-Funded Specify: ____________________________
*Source of
Scholarship/Research Institution-Funded
Funding
Grant Others:
_______________________________________
*Duration of Start date: No. of Study
the Study End date: Participants
*Has the Research undergone Technical Yes (please attach technical review results)
Review? No
*Has the Research been submitted to
Yes No
another REC?
2. Brief Description of the Study

3. Checklist of Documents
Basic requirements: Supplementary Documents:

Letter request for review Questionnaire (if applicable)

Endorsement/Referral Letter Data Collection Forms (if applicable)
Full proposal / study protocol Product Brochure (if applicable)
Technical Review Approval Philippine FDA Marketing Authorization or Import
Curriculum Vitae of Researcher/s License (if applicable)
Informed Consent Form Permit/s for special populations (please specify)
English Version Filipino _________________________________________
Version _________________________________________
Others __________________ Others (please specify)
Assent Form _________________________________________
English Version Filipino _________________________________________
Version
Others __________________

Accomplish

__________________________________
Signature
Date Submitted:
------------------------- To be filled by the REC Secretariat -------------------------
Completeness of Complete
Document Incomplete

Remarks

Date Received
Received by (place stamp here)