Clinical Study or Research Grant Request

Clinical Study Proposal Request for Investigator Initiated Studies Application

  • Clinical Study Proposal Request for Investigator Initiated Studies (IIS)

  • Please include address
  • Please include email, address, and telephone numbers for each PI
  • i.e. Will a study coordinator be assigned? Does your site have a central research department? Please include contact information for key study personnel not listed under PI.
  • Study Details

  • What are the specific aims of this study?
  • The endpoint on which the study is powered.
  • If applicable, please include any ERAS/PGDT treatment protocols.
  • Accepted file types: jpg, doc, pdf, docx.
    In the event IRB review is waived, please provide evidence of such.
  • Patient Population and Selection

  • Data Collection and Analysis

  • Study Duration

  • Miscellaneous

  • Include publication/conference submission plans
  • Additional Documents to be Provided

  • Accepted file types: jpg, doc, pdf, docx.
  • Accepted file types: jpg, doc, pdf, docx.
  • Accepted file types: jpg, doc, pdf, docx.
  • Accepted file types: jpg, doc, pdf, docx.