Title of Research Project* Dataset Requested* Exact Variables of interest excluding demographic variables (Not more than 2)* Details of person in charge of the project Name* Functional title* Email address* Phone* Details of the Organization Institute/University* Department/Office/Section* Head of Research/Department* Street* City/State* Email address* Phone* Other persons involved in the project (if any) Name Functional title Email address Phone Other persons involved in the project (if any) Name Functional title Email address Phone Brief Description of the Research Project (Please describe the goal and methodology of the research project, how the data will be used, how the findings will be disseminated, ethical issues to be considered, how the project will ensure data confidentiality and what safeguards will be taken to avoid stigmatization of population groups, and other relevant details; max 300 words):
