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CCTST

Center for Clinical and Translational Science and Training

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Proposal Registration and Consultation Request Form E-mail

Research Central
Investigators and research teams engaging in clinical and translational science across our Academic Health Center who would like to benefit from CCTST services and resources should register projects and proposals. Please complete the form below and submit it for processing. Our Research Central staff will review it and respond within 3 business days.  Guidelines on accessing support through Research Central are here.

Researcher Information

Researcher's
First Name:

Researcher's
Last Name:
 
Form Submitter (if different than researcher):
First Name:
Submitter Last Name:
   
Submitter Email:
Researcher's
Department:
Division:
Researcher's
Primary Institution:
UC     CCHMC     Cincinnati VAMC
Other: please specify:
Researcher's
Contact Info:

Office Phone:

Cell Phone:
 
Pager:
E-mail:

Researcher's
Terminal degree(s)

(Check all that apply)



Researcher's
Academic rank









If applicable, provide details of mentor (required for trainees and Instructor-level researchers, recommended for assistant professors):
  Mentor's Name:
  Mentor's Department:
  Mentor's Division:

Project Information

Project Title:
Project Description:
Upload Proposal File (optional):

Type of Study (check all that apply)
 

 
Funding source (check all that apply)


Data sources (check all that apply): Status of the data collection (select one):
 
 

Support requested

What type of support do you need? (check all that apply)
 
 
            Will questionnaires be completed by:    
patients/parents    
  local study staff     
 
 
 



     
     If you have already discussed this project with a methodologist, biostatistician, data analyst or data manager,
     please include their name(s):   


      Before submitting, verify your humanity by typing in the dark characters you see in the image below:
         
      This is a required field


   


 

NIH Acknowledgement: Publications resulting from the use of CCTST resources must credit the appropriate CCTST grant by including an NIH Funding acknowledgment.