P-CARRS Request Form

P-CARRS Request Form

Please submit all publication, presentation/abstract, and ancillary study requests by using this form.

Date of Request*

Investigator Name*

Email Address*

Senior Investigator/Author*

Please check this box if the Senior Investigator/Author has approved this submission.*

Additional Investigators

If you have already involved additional investigators/authors, please list them here. (optional).

Please check this box if the additional investigators have approved this submission.

Description

1 sentence to describe presentation, publication, or ancillary study of this request.

Type of Submission

You may select more than one IF every aspect of proposal is the same (ie. secondary data analysis for paper and ancillary study).

Publication

Presentation or Abstract

Ancillary Study

Target Journal

Target Conference

Date of Conference

Existing Funding

Do you have existing funding available for this study?

Yes

Funding Institution

If "yes," which funding institution?

Funding Amount

If "yes," how much funding?

Target Funder

NIH

Wellcome Trust

Other

If "Other," please provide here.

Relationship/Purpose of Request

Check all that apply.

Precision-CARRS Investigator

External Investigator

Pre-Doc Dissertation

Post-Doc Fellowship

Intermed. Fellowship

Senior Scientist Fellowship

Other

Target Population

Delhi-specific

Chennai-specific

Study-wide

Background

Please provide using 3 bullet points.

Objectives

Type of Data

Check all that apply.

Existing P-CARRS data

New data needed

Data Needs

Check all that apply.

Data collection

Data set only

Data analysis

Descriptive tables

Power analysis

Other

Study Design

Data and Variables of Interest

Please specify exposures, outcomes, and co-variates.

Methods and Analysis Plan

Timeline

Alignment with Precision-CARRS Agenda

Please describe how this supports the scientific goals of Precision-CARRS.

Study Implications

For ancillary study, please describe any study implications (ie. time for staff or participants, funding, etc.).

References

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