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.
*
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.
*
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.
*
Support needed: while a detailed budget is not needed at this stage, please indicate the level of support requested including, as applicable: devices, device training, preparation of study materials, electronic data capture, data analysis, algorithm development and direct funding.
*
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