Investigator Name
*
First Name
Last Name
Investigator Center:
*
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Concept and Rationale: please provide a succinct description of the rationale and purpose of your study.
*
Rationale: please provide 2 – 3 brief sentences describing the rationale for your idea.
*
Study design: please provide a high-level summary of the study design including study type (prospective, retrospective, QI project, other), patient population, anticipated N, and study duration.
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Design: please provide 2 – 3 brief sentences describing the proposed design.
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Experience: please provide a short description of the research environment (including hospital type) and personnel who would be involved in the study. For example, you can include information about the team’s experience with similar studies and availability of research support staff, if applicable.
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Research environment: please provide brief details on the research site and personnel.
*
Support needed: while a detailed budget is not needed at this stage, please list the estimated level of support requested (e.g., devices, algorithm development,funding, data analysis support, study design advice).
*
Have supporting documents to upload, do so here (e.g., draft protocol, draft budget, relevant related publications, CVs)
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