SIS Multicenter Application
Title of Study
*
Primary Investigator (PI) Name
*
First Name
Last Name
PI Email
*
example@example.com
PI Institution
*
Years of Practice
*
Is PI an SIS Member? (if no, will be required to join if study is chosen)
*
Yes
No
Background: (1-3 Sentences)
*
Hypothesis: (1 sentence)
*
Specific Aims
*
Study Design: (retrospective, prospective, etc)
*
Inclusion Criteria
*
Exclusion Criteria
*
Intervention: (1-3 Sentences)
*
Primary Outcomes
*
Secondary Outcomes
*
Sample size and Anticipated Number of Sites Required: (1-6 sentences)
*
Statistical Analysis Plan: (3-6 sentences)
*
Consent Procedures (if needed): (3-6 sentences - leave blank if not needed)
Risk / Benefit Analysis: (1-3 sentences)
*
Environment (Please describe the resources available to the PI that will ensure successful completion of the study) - (3-6 sentences)
*
References
*
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