Research Project Initial Form DRAA 610

Larkin Form DRAA-610

Initial Submission Form
Research Project Proposal

Initial Submission Form
Date*

MonthDayYear
Larkin Email*
example@larkinhospital.com
Personal Email*
example@mail.com
Initial SubmissionCompleted Scholarly work
Review of Evidence ( Systematic, Narrative, Scoping Reviews)Descriptive Studies (Epidemiologic and Surveys)Case SeriesExperimental StudiesQuality ImprovementQualitative ResearchEquity StudiesHealth Economic Studies( Cost Analysis, Cost Effectiveness, Cost Utility Analysis)Case ReportGrantLetter to Editor/EditorialsClinical Trial
Specialty Group*
Research Title*
Briefly describe why your topic is important (include fact, figures and contributing factors) and how it impacts your target audience?*

0/300
Author and Co-authors*
full names only separated by commas (e.g., Doe Jane, Smith John, ...)
YesNo
Team 11ResidentFellowNurse PractitionerOther
No, I am requesting faculty assignmentYes
If yes, name participating Faculty (at least two)*
Issue background*
With citations
Objectives*
Methods*
Brief description
My research project does not involve human subject and does not requires IRB review and approval.My research project involves human subject and may need full review by IRB Committee.I am not sure if my research project needs IRB review and approval
Please note that if you need IRB approval you will submit that in IRB Form. The IRB Forms are located on our DRAA website. https://www.graduatemedicaleducation.org/institutional-review-board/

You will also will find step by step helpful hints how to fill it up the IRB form by reviewing Instruction for IRB Protocol Submission. If you need further assistance please contact DRAA coordinator.
Upload Additional Documents (Optional)

Cancelof
Contact Person *
(First name, Last name)
Larkin Email
example@larkinhospital.com
ApprovedNot ApprovedRevision RequiredPending Revision by DRAA RepresentativeApproval Email sentCommittees Assistance RequestedIRB REQUIREDNO IRB REQUIREDRevision Required Email SentSend to Committees
Review Notes
Should be Empty:

Larkin Form DRAA-610

Research Project Proposal