NEXT Access Request Form

NEXT Access Request Form

Date of Access Request Submission

Person Requesting Access

Research Role:

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Institution Name

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Email Address

Phone Number

Study

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Type of Access Needed:*

REDCap

Sharepoint Website

Email Distribution Group

Coordinator Training Session

Quarterly Data Calls (CRCs only)

Dates for Coordinator Training

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REDCap User Agreement Uploaded

Acknowledgement of NCH Tech. and Conf. Agreement*

File Upload*

Please upload all required documents individually.

Drag and drop files here or

DOA Uploaded*

Training Log Uploaded*

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