Medidata Global Partner Program Application
Thank you for your interest in the Medidata Partner Program.
Because we recognize the value of our partners, we are continuously striving to improve these relationships. These efforts have lead to the development of web-based materials, forms and eLearnings to make the program available in a way that is more flexible, on-demand and of lower cost to partners.
Please fill out the brief form below to begin the application process. An authorized representative from your organization will need to accept the terms and conditions at the end of the form. You will be contacted within 2 business days from submitting the application.
The country in which your company is headquartered.
Your title within the company.
VP / Department Head
COO / CMO / CFO / CIO
CEO / President / Managing Director
Your department or functional area within the company.
Biometrics and Statistics
Clinic / Hospital / Site
Manufacturing / Supplies
Outsourcing / Vendor Management
Research and Development
Safety / Pharmacovigilance
Approximate number of employees in your company.
101 - 500
501 - 1000
Primary Market Geography
Indicate the market geography that drives most of your company's revenue. If there is no clear primary region, then select "Multiple Geographies". Use the check-boxes below to indicate all the regions where your company does business.
Asia Pacific (APAC)
Europe, Middle East, Africa (EMEA)
Active in North America
Active in Latin America
Active in EMEA
Active in APAC
Primary Market Segment
Indicate the market segment that drives most of your company's revenue. If there is no clear primary segment, then select "Multiple Segments". Use the check-boxes below to indicate all the segments in which your company does business.
Academic / Nonprofit
Active in Academic / Nonprofit segment
Active in Biotech segment
Active in Government segment
Active in Medical Device segment
Active in Pharma segment
Annual Gross Revenue
Estimated AGR for last year.
< $1 million
$1 - $5 million
$5 - $10 million
$10 - $50 million
$50 - $100 million
> $100 million
List the number of studies per year you are starting.
How many study starts do you have each year that would be suitable for paper?
10 - 20
20 - 50
Phase I EDC Studies
How many Phase I studies do you start each year?
10 - 30
Phase II/III EDC Studies
How many Phase II/III studies do you start each year?
10 - 30
Post-Approval EDC Studies
How many Post-Approval studies do you start each year?
10 - 30
Other EDC technology partnerships
Please specify any partnerships you have with other EDC technology providers.
What are your organization's strengths that differentiate it from other competitors in your market segment(s)? What helps you win business?
Primary Therapeutic Area
If there is a particular therapeutic area that your company is focused on, indicate that here. Use the check-boxes below to identify all therapeutic areas in which your company is active.
Central Nervous System
Devices and Diagnostics
Pain and Analgesia
Multiple Therapeutic Areas
Central Nervous System
Devices and Diagnostics
Pain and Anesthesia
Use the check-boxes below to identify the various clinical service offerings that your company provides.
Study & Protocol Design
Trial Planning and Budgeting
Site Negotiation & Payments
Randomization and Trial Supply Management
Electronic Data Capture (EDC)
Safety Data Capture
Medidata delivers a cloud-based platform of innovative tools, data-driven metrics and system interoperability, all designed to optimize clinical trials from concept to conclusion. Please identify the Medidata Clinical Cloud applications that interest your organization at this time?
Study Design and Budget
Build better execution right into your study design and budget.
Study Design Optimization
Make life better for your site partners and for you.
Medidata Site Payments
Unleash the power of patients as partners.
Medidata Patient Cloud: ePRO
The world’s leading cloud solution for executing clinical trials faster, safer and at lower cost.
Medidata Rave: EDC
Rave Safety Gateway
Medidata Balance: Randomization and trial supply
Enablement Team Size
How many employees do you expect will participate in Medidata training as part of the partner accreditation process?
3 (program minimum requirement)
4 - 10
Legal Terms Agreement
By submitting this application form, the parties agree to be bound by the following confidentiality terms. Any and all information contained in this Medidata Partner Application Form ("Application Form") and exchanged by the parties through the selection process is proprietary and confidential to the disclosing party ("Confidential Information"). The information contained in this Application Form may be used solely in connection with the evaluation of the Medidata Partner Program.
To the extent a nondisclosure agreement (or other agreement with terms of confidentiality) protecting Confidential Information is in effect between the parties, the information contained in this document and exchanged by both parties through the selection process shall be held confidentially in accordance with the terms of that agreement. If no agreement protecting the parties' Confidential Information is in effect between the parties, both parties agree to (a) keep the Confidential Information in strict confidence and not to disclose it to any third party without the other parties prior written consent and (b) the parties internal disclosure of Confidential Information shall be only to employees, contractors or agents having a need to know such information in connection with the evaluation of the selection process and only insofar as such persons are bound by a nondisclosure agreement consistent with the foregoing. Neither party will acquire any intellectual property rights in the other parties property under the Application Form and or through the selection process.
Check this box to accept these terms:
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