Support Request Form

To download a PDF version of this support request form click here.

Applicant Details
Name of lead applicant:
Current post:
Institution:
Telephone:
Email:
Names of co-applicants:
Project Details
Research question/Project Title:
Anticipated start date:  dd/mm/yyyy
Total duration of study:  months
Number of participants:
Number of centres:
Intervention(s) (if relevant):
Control/comparison (if relevant):
Is it a CTIMP?:
Outcome measures:
Time points of data collection:
What assistance or support would you like the Peninsula Clinical Trials Unit to provide? (please tick all that apply):



Have you had any input from any other source? (please tick all that apply)
 
Are you applying for funding?
What is the target funding body?
If yes, what is the deadline for application?

Peninsula Medical SchoolNHSUKCRC Registered Clinical Trials UnitsPenCLRN

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