VITA - Study Application Form

Study Application Form
Project Title*
Project Number
Internal notes (please do not fill in)
The investigators do have the full ethical/medical responsibility for the proposed study.
Principal Investigator
Titel
Name*

VornameNachname
Position
University / Institute
Department
Phone

CountryAreaNumber
Fax

AreaNumber
E-Mail
beispiel@beispiel.de
Adresse

Street / Nr

Straße und Hausnummer (zweite Zeile)

CityCountry

ZipCountry
Please add a short curriculum vitae, the letter of motivation, five important publications and relevant projects concerning the proposed study of the principal investigator.
Datei-Upload

pdf, doc
Cancelof
Additional Investigator
Titel
Name

VornameNachname
Position
University / Institute
Department
Phone

CountryAreaNumber
E-Mail
beispiel@beispiel.de
Please add a short curriculum vitae, five important publications and relevant projects concerning the proposed study of the additional investigator.
Datei-Upload

pdf, doc
Cancelof
Additional Investigator
Titel
Name

VornameNachname
Position
University / Institute
Department
Phone

CountryAreaNumber
E-Mail
beispiel@beispiel.de
Please add a short curriculum vitae, five important publications and relevant projects concerning the proposed study of the additional investigator.
Datei-Upload

pdf, doc
Cancelof
Additional Investigator
Titel
Name

VornameNachname
Position
University / Institute
Department
Phone

CountryAreaNumber
E-Mail
beispiel@beispiel.de
Please add a short curriculum vitae, five important publications and relevant projects concerning the proposed study of the additional investigator.
Datei-Upload

pdf, doc
Cancelof
Type of Research Project
Type of Research Project

preclinical study
experimental studycell studyanimal study
Type of Research Project

clinical study
multicenter studysingle center study
prospective clinical studyrandomizednon randomized observercohort study
retrospective clinical studycohort studycohort study with control
ethic commission

ethic commissiondoneplaned
Project Period*
Project costs and additional budget?

noyes
Materials needed?
What VITA materials will be needed according to VITA compendium?
Quantity / Description / Articel number
This is the summary of your research project.
Objectives and purposes
Project design
Hypothesis
Study Application Form
Relevance of the project
Statistical method (who manages the data? / who performs the statistical analyses?)
Study Application Form
Material and method (quantity, product name, manufacturer)
Project schedule (milestones for ex. Estimated date of the first draft of publication etc.)
Summary (information for the public)
Principal & Additional Investigators

Date / Name / Signature
Date

MonatTagJahr
Datum
Name
Sinature

Clear
Date

MonatTagJahr
Datum
Name
Sinature

Clear
Date

MonatTagJahr
Datum
Name
Sinature

Clear
Date

MonatTagJahr
Datum
Name
Sinature

Clear
Should be Empty:

Study Application Form

Principal Investigator

Additional Investigator

Additional Investigator

Additional Investigator

Type of Research Project

Materials needed?

Study Application Form

Study Application Form

Principal & Additional Investigators