Project Registration Form

Date: May 24, 2013

Date of Initial Contact (if other than today's date):

Email Address of Person Completing Form:

Project Title:

Primary Investigator: First Name:      Last Name:      Suffix:

PI Email:

Department:

Co Investigators:

Is This In The Project/Study Development Phase? (has not been submitted and/or received Institutional Approvals)
Yes     No

Are you applying for a Grant?:
Yes      No

Grant Deadline Date:

Please indicate if you are submitting to one of the following Peer-Reviewed Funding Organizations:
if other:

Human Subject Certification (including Exempt studies):
IRB Approval # Date

Vertebrate Animals:
IACUC Approval # Date

Cancer or Cancer Related:
Yes     No

Do You Need Statistical Analysis?:
Yes     No

Do You Need Data Management?:
Yes     No

Center Affiliation:(if applicable)Indicate All that Apply:
Cardiovascular Research Institute (CVRI)
Center for American Indian Community Health (CAICH)
Center for Child Health and Development
Center for Childrens Healthy Lifestyles and Nutrition
Center for Healthcare Informatics
Center for TeleMedicine and TeleHealth
Center for Viral Oncology
Frontiers: The Heartland Institute for Clinical and Translational Research
Hoglund Brain Imaging Center
Institute for Molecular and Outcomes Medicine
Institute for Neurological Disorders
Institute for Reproductive Health and Regenerative Medicine
Institute of Community and Public Health
Integrative Medicine
Interdisciplinary Center for Male Contraceptive Research and Drug Development
IM-OSARM
Internal Medicine Research Office (IMRO)
Kidney Institute
KU Alzheimers Disease Center
KU Diabetes Institute
Landon Center on Aging
Liver Center
Radiology
Smith Intellectual and Developmental Disabilities Research Center
The University of Kansas Cancer Center


Please select any Department of Biostatistics Faculty currently associated with this project:

Dr. Michael Brimacombe
Dr. Prabhakar Chalise
Dr. Francisco Diaz
Dr. Frank Dong
Dr. Brooke Fridley
Dr. Byron Gajewski
Dr. Jianghua He
Dr. John Keighley
Dr. Jonathan Mahnken
Dr. Matthew Mayo
Dr. Milind Phadnis
Dr. Vincent Staggs
Dr. Philip Twumasi-Ankrah
Dr. Russ Waitman
Dr. Jo Wick
Dr. Henry Yeh


Additional Comments, Description, or Other Information:




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