University of the Immaculate Conception

REC_FO_0022
Research Ethics Committee (REC)
Control No.: _________
Bonifacio Street, Davao City, Philippines

Ethics Review Checklist

STUDY PROTOCOL INFORMATION

Control No. Protocol Code:
Study Protocol Title
(Title of Study) 

Principal Investigator 
(Researcher/s)
Study Protocol Submission Date

Telephone No. (082) 227-82-86 (loc. 211) ● Email Address: rpic@uic.edu.ph Page 1 of 5
 University of the Immaculate Conception
REC_FO_0022
Research Ethics Committee (REC)
Control No.: _________
Bonifacio Street, Davao City, Philippines

Verified Complete By

Basic Requirements (must submit)

 Updated Curriculum Vitae (CV) of the Adviser(s) and the Researcher (At least 1
copy)
 Updated Research Agenda of the Program (for Non-UIC student)
 All grades [certificate of grades – from the registrar] or screenshot of ONLINE
Grades

Telephone No. (082) 227-82-86 (loc. 211) ● Email Address: rpic@uic.edu.ph Page 2 of 5
 University of the Immaculate Conception
REC_FO_0022
Research Ethics Committee (REC)
Control No.: _________
Bonifacio Street, Davao City, Philippines

 Photocopy of the receipt (1 copy)

 Ethics Review Endorsement Form (duly signed)
Full Board (require to submit 5 copies each if face to face but only one if online )
 Revised (IF available) copy of the manuscript (plain BLACK text)
 Minutes of the proposal defense (Documenter’s Note)
 Routing Form (IF available)
 Ethics Review Checklist (REC_FO_0022)

Telephone No. (082) 227-82-86 (loc. 211) ● Email Address: rpic@uic.edu.ph Page 3 of 5
 University of the Immaculate Conception
REC_FO_0022
Research Ethics Committee (REC)
Control No.: _________
Bonifacio Street, Davao City, Philippines

 Application Form [with human] (REC_FO_0023)

 Study Protocol Assessment Form (REC_FO_0024)
 Study Protocol Information Form (REC_FO_0025)
 Informed Consent Assessment Form (REC_FO_0026)
 Informed Consent Form when Questionnaires are used (REC_FO_0027)
 Sample Informed Consent (REC_FO_0057)

Telephone No. (082) 227-82-86 (loc. 211) ● Email Address: rpic@uic.edu.ph Page 4 of 5
 University of the Immaculate Conception
REC_FO_0022
Research Ethics Committee (REC)
Control No.: _________
Bonifacio Street, Davao City, Philippines

 Sample Assent Form (REC_FO_0057B) (for below 18-year-old respondents)

 Sample MOA for Authorship (REC_FO_0058)

Telephone No. (082) 227-82-86 (loc. 211) ● Email Address: rpic@uic.edu.ph Page 5 of 5