Research Project Initial Form DRAA 610

Larkin Form DRAA-610
Research Project Proposal

Initial Request Form
Larkin Email*
example@larkinhospital.com
Date*

MonthDayYear
Submission Type*

Initial SubmissionCompleted Scholarly work
Type of Research Project*

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*
(Include study purpose, design, target population/ setting)
Briefly describe why your topic is important (include fact, figures and contributing factors) and how it impacts your target audience?*
Author and Co-authors*
Do you require Assistance from the Professional Committees*

YesNo
Original Idea Developer*

Team 11ResidentFellowNurse PractitionerOther
Have you identified Faculty for this project ?*

No, I am requesting faculty assignmentYes
If yes, name participating Faculty (at least two)*
Issue background*
With citations
Objectives*
Methods*
Brief description
IRB Review & Approval*

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)
This section will be completed by DRAA representatives only

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