ERC Form 02: Registration and Application Form

26 September 2022 Version 1

Colegio de la Purisima Concepcion

The School of the Archdiocese of Capiz, Roxas City
Roxas City 5800, Philippines
Tel. (036) 6215-331
ETHICS REVIEW COMMITTEE

REGISTRATION AND APPLICATION FORM

INSTRUCTION:
The registration and application form is required for all ERC submission and resubmission. Upon completing this form, print this
form in Letter size paper, sign this form, and date your signature prior to submission.

SECTION I: APPLICATION INFORMATION

Researcher: [Title, Name, Surname] MS. ARGELINE JOY J. AMORES

Birthdate: [DD/MM/YYYY] 10/12/1995

Researcher Address: ST. FRANCIS PARK SUBDIVISION, TANQUE, ROXAS CITY, CAPIZ

Researcher Telephone/Mobile: 09773527417 / (036) 6320273

Researcher Email: argelinejoyamores@gmail.com

1. Type of Submission: o 1.1 Initial Review

o 1.2 Resubmission (responses to initial review recommendations prior to ethics
approval).
o 1.3 Application for Exemption from CPC-ERC Review (for official declaration of study
exemption from ethics review)

2. Date of Submission: [DD/MM/YYYY]

3. Study Category: o 3.1 Research involving human participants
o 3.2 Others (please indicate): ___________________________________

o 4.1 Experimental/Interventional Research

o 4.2 Non-Experimental Research:
o 4.2.1 Correlational Research
o 4.2.2 Comparative Research
o 4.2.4 Descriptive Research
o 4.2.5 Evaluative Research
o 4.3 Qualitative Research
o 4.4 Others (please indicate): ___________________________________
4. Category of Researcher: o 5.2.1 CPC Undergraduate Student (specify College/Department):
__________________________________________________
o 5.2.2 CPC Graduate Student
o 5.2.3. CPC Faculty (specify College/Department):
__________________________________________________

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ERC Form 02: Registration and Application Form
26 September 2022 Version 1

5. Purpose of Study: o 6.1 Academic Requirement (Thesis/Dissertation Requirement)

o 6.2 Independent Research Work
o 6.3 Others (please indicate): ___________________________________
6. Research (Working) Title: EMOTION REGULATION IN THE EYES OF SOCIAL WORKER PROVIDERS

7. Endorsing College/
Department:

8. Study Site:
9. Funding Agency: 9.1 (NAME):

9.2 TYPE OF FUNDING AGENCY:

o 9.2.1 CPC Unit
o 9.2.3 Researcher-Initiated
o 9.2.4 Government Agency/Office/Entity
o 9.2.5 Private Company or Non-Governmental Organization (NGO)
o 9.2.7 Others (please indicate): ____________________________________

10. Study Budget:
11. Declaration of Conflict of
Interest of PI:
12. Other investigators with
corresponding task
description (add additional
rows as applicable):
NOTE: This refers to line-item amounts. However, if a separate budget sheet is available,
just indicate total amount and attach budget sheet
50,000
TOTAL BUDGET: _______________________________________________
o 11.1 I have no conflict of interest in any form (financial, proprietary,
professional) with sponsor, the study or the site.
o 11.2 I have personal/family financial interest in the results of the study.
NATURE:
Co-Researcher/Research Assistant/Data Collector:
Task description:
Co-Researcher/Research Assistant/Data Collector:
Task description:

Co-Researcher/Research Assistant/Data Collector:

Task description:

13. Researcher Signature:

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