SIU ClinCard Account Build Request Form

Study Name*

This does not need to be the full title of the study. The short study name is sufficient.

Study ID (optional)

This is how you could choose to identify the study in Greenphire.

Study Status*

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Description (optional)

This is how you could choose to describe the study in Greenphire.

Study Sponsor

Card Type*

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Principal Investigator Name*

Study Personnel*

Please select all study personnel who will need access to Greenphire for this study.

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File Upload*

Please upload a stipend schedule or internal budget. Study visit name and amount of stipend are required.

Drag and drop files here or

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