Appendix 0

TAGUM DOCTORS COLLEGE, INC

Mahogany St., Rabe Subd., Tagum City
APPLICATION FORM FOR ETHICS REVIEW OF RESEARCH
PROPOSALS
Instructions To The Researcher: Please Accomplish This Form And Ensure That You
Have Included In Your Submission The Documents That You Checked Below.
I. GENERAL INFORMATION

TITLE OF STUDY: Isolation and Identification of Salmonella and Escherichia coli

from ground pork, beef and chicken meat at Tagum Public Market

STUDY SITE: Tagum Doctors College School Laboratory

DEPARTMENT: Bachelor of Science in Medical Laboratory Science

TYPE OF STUDY: Descriptive Quantitative

SOURCE OF FUNDING: None

NAME OF RESEARCHERS: Ballena,Mallorie M

Calunsag, Kristine Mae M.
Ceniza, Venice Marie Y.
Magparo, Kriz Ann Joy C.

CONTACT INFORMATION: Sir. Romuald Velario, RPh, MSPharm

MOBILE NUMBER: 09187688342

CO-RESEARCHER/S: None

EMAIL: lhoriedelavinge@gmail.com

DURATION OF THE STUDY: 4 months

START DATE: Third week of August, 2019

END DATE: Third week of October

 TAGUM DOCTORS COLLEGE, INC
Mahogany St., Rabe Subd., Tagum City
Bachelor of Science in Medical Laboratory Science

Mrs. Berlina C. Vargas, RPh

Laboratory In-Charge
Tagum Doctors College,Inc.

Good Day Ma’ám,

We the 4th year of Bachelor Science in Medical Laboratory Science students from
Tagum Doctors College, Inc., are conducting a research study about the isolation an
identification of bacteria microorganisms.
In line with this, we would like to request from your laboratory to use one of your
facility this coming August 24, 2019

Biosafety Cabinet
Your positive response will be appreciated and will greatly help us in the
fulfillment of our research. Thank you so much and God bless.

Sincerely Requesting,
4th YEAR BSMLS STUDENTS
Ballena,Mallorie M
Calunsag, Kristine Mae M.
Ceniza, Venice Marie Y.
Magparo, Kriz Ann Joy C.

Noted by:
DRA. BEVERLY ROSE D. SARIP , RPh,RMT ROMUALD VELARIO, RPh
Program Head Adviser
 TAGUM DOCTORS COLLEGE, INC
Mahogany St., Rabe Subd., Tagum City
Bachelor of Science in Medical Laboratory Science

Mrs. Berlina C. Vargas, RPh

Laboratory In-Charge
Tagum Doctors College,Inc.

Good Day Ma’ám,

We the 4th year of Bachelor Science in Medical Laboratory Science students from
Tagum Doctors College, Inc., are conducting a research study about the isolation an
identification of bacteria microorganisms.
In line with this, we would like to request from your good office to use the
Manufacturing Laboratory this coming Saturday, August 24, 2019 for the experimental
conduct of our research study.
Your positive response will be appreciated and will greatly help us in the
fulfillment of our research. Thank you so much and God bless.
Sincerely Requesting,
4th YEAR BSMLS STUDENTS
Ballena,Mallorie M
Calunsag, Kristine Mae M.
Ceniza, Venice Marie Y.

Magparo, Kriz Ann Joy C.

Noted by:
DRA. BEVERLY ROSE D. SARIP , RPh,RMT ROMUALD VELARIO, RPh
Program Head Adviser