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UConn Pepper Center Resource Core Application
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This form is broken down into 4 steps. Please fill out Step 1 below and click the "Next Page" button to continue through the form process.
Title of Study
IRB Number
Date Approved
MM
/
DD
/
YYYY
Principal Investigator/Applicant
Institution
Department
Address
Street Address
City
State / Province / Region
Postal / Zip Code
Email
Telephone
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Fax
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Study Coordinator
Study Coordinator E-Mail
Funding Source
Brief Description Of The Study (Aims, Dependent and Independent Variables):
Projected Start Date
MM
/
DD
/
YYYY
Projected End Date
MM
/
DD
/
YYYY
Description of Sample Size:
Inclusion Criteria:
Exclusion Criteria:
IRB Approved Recruitment Processes:
Notes/Comments:
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