Non-KYCOM Affiliated Research Report Form

Non-KYCOM Affiliated Research Report Form
Name*

First NameLast Name
Class of*
Title of the Research Project*
Type of the Research Project*
(Case study, Bench Work, Review, etc.)
Period of the Research Conducted
From*

MonthDayYear
Date
To*

MonthDayYear
Date
Research Project Approvals by IRB or IACUC (if applicable)
Date of Submission

MonthDayYear
Date
Date of Approval/Exemption

MonthDayYear
Date
Abstract of the Research Project*
Name of Research Institution*
Contact of the Outside Principal Investigator
Name*
Phone*
Format: (000) 000-0000.
Email*
example@example.com
Manuscript Submission
(Title, Authors, Affiliations, Journal)
Conference Submission
(Title, Authors, Affiliations)
Proof of Manuscript/Conference Acceptance and Registration

Browse Files

Cancelof
Should be Empty: