CWIS Research Study Proposal

CWIS Research Study Proposal

Online request form
Proposal forms must be completed in its entirety, incomplete forms will not be considered.

All data submissions should be entered through this CWIS Research Study Review website portal. Submissions will be reviewed monthly by the CWIS Research Committee, and then prospective Primary Investigator will be notified of results.

Questions?

If you have any questions, please submit your inquiry to information@cwisociety.org.
General Information
Study Title *
Primary Investigator/Senior Researcher *

First Name Last Name Credentials
Preferred email for Primary Investigator/Senior Researcher *
example@example.com
Primary Investigator/Senior Researcher (#2 if applicable)

First Name Last Name Credentials
Preferred email for Primary Investigator/Senior Researcher (#2 if applicable)
example@example.com
Are you a current member of CWIS?

Yes No
If you selected "No" above please identify a Sponsor that is an active CWIS member:

First Name Last Name Credentials

Background & Significance
My study proposal is... *

Retrospective Prospective
Please briefly outline the burden of the problem to be examined. *
(1-2 paragraphs only)

Experiemental Design/Methods
Inclusion criteria *
Exclusion criteria *
Therapeutic interventions *
Data repository

Chest Injury International Database (CIID) RedCAP
What IRB needs do you anticipate?

Individual IRB approval Central IRB approval No IRB approval needed

File upload portal 1 (if applicable)

Browse Files
You may upload more than one file into this portal. Due to technical limitations, maximum file size for each file is capped at 100MB when using this option. If file size exceeds this limit, load files individually in each portal. Cancel of
Comments
Electronic signature

Clear
Today's Date

Month Day Year
Date
Questions?

If you have any questions, please email CWIS at information@cwisociety.org.
Should be Empty:

Questions?