Research application form

1. Primary Contact

The primary contact is the person to whom all questions about the application will be directed.

Name (required):
Email (required):
Phone Number:
Mailing Address:
Organization:

2. Principal Investigator

If the Principal Investigator is same as Primary Contact you may leave these fields blank, otherwise specify below.

Name:
Email:
Phone Number:
Mailing Address:
Organization:

3. Study Team

Please describe any co-investigators, students, etc., including names and title/roles (required):

Please describe any other partnerships (Strategic Clinical Networks, universities, industry, collaborators), including names and title/roles of collaborators (required):

4. Ethics Approval Letter and Ethics Application

Attach copy of approval letter (required at time of application)(max size: 5 MB):

Attach copy of ethics application (required at time of application)(max size: 5 MB):

Note: If the ethics application includes all components listed under Section 5 and 6 below, you are not required to fill out these sections.

5. Project Description

Project Title:
Lay Abstract or Rationale:
Briefly describe your project in plain language so a lay reader with no experience in your research area will understand (250 words/2000 characters)

Research Question(s):

Method:
i. Inclusion and Exclusion Criteria

ii. Procedure:

iii. Variables of Interest (data elements required):

iv. Anticipated Analyses:

v. Timeline:

6. Study Protocol

Attach copy of protocol letter (required at time of application)(max size: 5 MB):

7. Services Required from ABJHI

Requested Service(s): (check all that apply)DataData Linkage(s)Data AnalysisData CollectionForm DesignAnalysis Plan DevelopmentStudy Design and Execution (e.g. RCT, prospective cohort study)Report, Manuscript, Abstract WritingProject ManagementLetter of SupportOther (describe below):

Requested Resource(s): (check all that apply)Unknown/UnsureData AnalystBiostatisticianProject ManagerSenior ResearcherOther (describe below):

8. Alignment with ABJHI Research Priorities

Briefly describe how the proposed research project aligns with the ABJHI mandate and research priorities.

By checking this box, I confirm that the information provided is correct.

A copy of the submitted application will be emailed to you for your records. After you submit the form, please submit the application fee (via PayPal or cheque).