Study Proposal Application Form

Submission Date

Investigator Name^*

Medical and/or Research Specification

Institution Name^*

Department

Address

Phone number^*

Email address^*

Study Titles

Other Studied Indications

Other Research Focus

Number of Inovivo system requested?

Type and number of animal arrays needed for the first year ^*

Specific Aims

Background and Rationale

(If Applicable) Preliminary Studies

Research Design and Methods

Implications for Clinical Practice

References

Letter of Intent Decision to MTA

Publication Plan

Study Start Date

Study Duration

(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.

If yes, Please indicate the details

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

(If Applicable) Please provide information on animal facility

Please provide details (TTFields)

If yes please indicate the request details

Please describe if your intention is to translate the findings of this study to animals and/or clinical studies