COVID-19 Clinical Research Review Panel: Submission Form

Please complete this form to request review of your COVID-19 clinical research.

Protocol Title *

PD *

PD Dept./ Div. *

Study Design *

Study Size

Estimate the number of individuals

Brief Study Rationale and Design *

Key Collaborators

Will the research require any member of the research team to be on the Stanford campus, Stanford hospital or Stanford affiliated hospitals (PAVA, Valley Care, SCVMC)? *

Will the research potentially require Stanford Children's Services? *

Funding Source

IND or IDE Required *

eProtocol # (if available)

Additional Comments or Questions

Upload Supporting Documents (protocol, informed consent, etc.)

Drop your files here

Submitter SUNet ID

*

Send me a copy of my responses