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Institution/Organization
applying for
Registration |
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About
Institution |
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Name of
Institution: |
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City: |
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State: |
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Postal Address: |
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Phone Number: |
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Fax Number: |
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Email Address |
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Website |
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About Head of
Institution |
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Name
of Head of
Institution |
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Postal Address: |
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Phone Number: |
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Fax Number: |
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Email Address |
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(Please include
a letter from
the authorized
head of the
institution
applying for
registration of
health research
ethics committee
which should
include a
statement that
the Chairman of
the Health
Research Ethics
Committee
reports directly
to the Head of
the Institution) |
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Health Research
Ethics Committee |
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About
Institutional
Health Research
Ethics Committee |
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Name
of Institutional
Health Research
Ethics Committee |
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Postal
Address (If
different from
address of
institution
above):
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Phone Number: |
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Fax Number: |
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Email Address |
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About
Administrative
Set-up of
Institutional
Health Research
Ethics Committee |
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Administrative
Officer |
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Name of
Administrative
Officer |
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Qualifications |
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Phone number |
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Fax number |
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E-mail address |
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Administrative Officer’s Ethics or Informed Consent Training in the preceding 2 years |
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Course |
Duration of
training |
Was this course
approved by
NHREC |
Organizers |
Certificate
Obtained (if
any) |
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Number
and Types of
Researches
Reviewed by your
Institution in
the past 2 years |
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Clinical Trial
of Drugs |
Number of Researches
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Clinical Trial
of New
Technologies/Procedures |
Number of Researches
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Social and
Behavioural
Research |
Number of Researches
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Basic Sciences
Research |
Number of Researches
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Applied Sciences
Research |
Number of Researches
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BSc Students'
Research |
Number of Researches
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MSc Students'
Research |
Number of Researches
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PhD Students'
Research |
Number of Researches
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Research by
other category
of trainees |
Number of Researches
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Number
and Types of
Sanctions
received by the
Institutional
Health Research
Ethics Committee
in the past 2
years
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Type of sanction |
Number of times |
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From institution |
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From the
National Health
Research Ethics
Committee |
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From
International
Health Research
Ethics
Regulatory
Agency, please
specify |
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About Chairman and Members of Institutional Health Research Ethics Committee |
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Fullname
(Surname,
Othername) |
Sex |
Qualifications |
Primary
Scientific or
Non-Scientific
capacity |
Representative
capacity |
NHREC approved
Courses attended
in the last 2
years (Title of
course, venue,
dates) |
Certificates
obtained, if any |
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Institutional Commitments |
As part of the
requirements of
Registration of
HREC,
Please download
a copy of
Institutional Commitments
file,
fill (dully sign
where
appropriate), scan and
submit back
through the website
or email it to
deskofficer@nhrec.net
By submitting
this
application, we
understand the
responsibilities
of the
Institution and
HRECs as
described in the
National Code
for Health
Research Ethics
in Nigeria and
hereby make a
commitment to:
a)
Abide by the
provisions of
the code
b)
Provide adequate
space for
meeting, and
record keeping
purposes for the
HREC
c)
Provide the HREC
with adequate
support to
facilitate its
work
d)
Take full
responsibility
for actions of
HREC members
undertaken in
the cause of
serving the HREC
including legal
liability
for
each member |