REC Form No: 1C

Version No: 03

1C. Curriculum Vitae Form Approval Date: 06/15/2022

Effective Date: 08/15/2022

GENERAL INFORMATION
Name: Date of Birth:

Address: Contact number:

Email Address:

Affiliation: Position: Name of Institution: Department:

UB-REC Position: Specialty:

Highest Educational Name of Institution: Course/Degree: Years attended:

Attainment:

Research Related Name of Course: Offered by: Year:

Trainings including
Research Ethics:

Name and signature: Date: