Research Committee Review Form

Meeting Date:

Does the research involve prohibited sponsorship and conflicts*:

YesNo

Committee Members in Attendance:

James LindenBritt GranathKatherine MichelmoreAndrew Gow

Additional Committee Members on this Project:

Will COORDINARE retain ownership of our own IP, including IP in our data?

YesNo

Will COORDINARE be restricted from publishing results of our projects?

YesNo

Research Project Name:

Request Received From (name / contact details):

Request Received From (organisation):

Project Time Frame:

Funding Provider:

Project Funding:

Is there a cost to COORDINARE:

YesNo

If yes, projected cost and the reason why:

Is in-kind funding available:

YesNo

If yes, dollar amount:

NOTE : If costs to COORDINARE or in-kind funding, the research project MUST be approved by the CEO and CFO

Signature and Date of Signing: Prue Buist, CEO - COORDINARE

Signature and Date of Signing: Stephen Packer, CFO - COORDINARE

Does the project align with COORDINARE's Strategic Priorities:

YesNo

Which Strategics Policies:

Possible risks to COORDINARE:

ReputationFinancialPrivacy Issues

Other possible risks to COORDINARE:

Other Forms of Involvement:

Is there interest in COORDINARE:

YesNo

Is there capacity for someone in COORDINARE to be lead contact:

YesNo

COORDINARE Lead Contact (name / contact details):

Anticipated Time Commitment from COORDINARE:

Is COORDINARE currently participating in research related to this topic?

YesNo

If yes, name of research:

Is there a potential for financial or reputational benefit to COORDINARE?

YesNo

Actions out of meeting?

RESEARCH COMMITTEE APPROVAL:

ETHICS COMMITTEE APPROVAL:

YesNo

YesNoPending

Research Committee: Date of Approval

Ethics Committee: Date of Approval / Providing Organisation:

REPORTED TO THE BOARD:

YesNo

Date Reported to the Board:

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