Date:
11/07/2009
Project Number
4338-7521-4475
Date of Initial Contact (if other than today's date):
Email Address of Person Completing Form:
Project Title:
Primary Investigator:
Department:
Phone:
PI Email:
Co Investigator(s):
Is This In The Project/Study Development Phase? (has not been submitted and/or received Institutional Approvals)
Human Subjects Certification (including Exempt studies)
IRB Approval #:
Date:
Vertebrate Animals
IACUC Approval #:
Date:
Cancer or Cancer related:
Primary Disease Site:
Do You Need Statistical Analysis?
Do You Need Data Management?
Center Affiliation (if applicable) Indicate All that Apply:
Landon Center on Aging
Hoglund Brain Imaging Center
Kidney Institute
Center for Environmental & Occupational Health
Center for Reproductive Sciences
Developmental Disabilities Center
General Clinical Research Center (GCRC)
Smith Intellectual & Developmental Disabilities Research Center (SIDDRC)
The University of Kansas Cancer Center
Center for Physical Activity, Nutrition & Weight Management
Heartland Institute for Clinical and Translational Research (HICTR)
Institute for Advancing Medical Innovation (IAMI)
Please select any Department of Biostatistics Faculty currently associated with this project:
Dr. Matthew Mayo
Dr. Byron Gajewski
Dr. Jianghua (Wendy) He
Dr. John D. Keighley
Dr. Jonathan D. Mahnken
Dr. Jo Wick
Dr. Henry Yeh
Comments, Description or Other Information:
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