Study Proposal Application Form

Investigator Name^*

Medical and/or Research Specification

Institution Name^*

Department

Address

Email address^*

Phone number^*

Study Titles^*

Specific Aims^*

Background and Rationale^*

(If Applicable) Preliminary Studies

Research Design and Methods^*

Implications for Clinical Practice^*

References^*

Estimated start date:

Estimated study duration:

Publication plan:

(If Applicable) Post-Doctoral Fellow ​number of personnel​

(If Applicable) PhD Student ​number of personnel​

(If Applicable) Research Technician ​number of personnel​

(If Applicable) Other - ​Click or tap here to enter text.​

If yes, please describe your experience

If yes, please specify

Please provide information on laboratory infrastructure and equipment relevant to the proposed research.

(If Applicable) Please provide information on animal facility

If yes, please describe if your intention is to translate the findings of this study to animals and/or clinical studies