Request for CRRO Services

Please select the type(s) of your request: *

Regulatory
Recruitment

1) Please provide a brief description of your request*

2) Contact information for the person who will be working with CRRO for this consultation

Name*

FirstLast

Email Address*

If you have provided the information below for previous CRRO consultations, you may skip to question 3.

Degree(s)

Faculty rank (if applicable)

Role in this study

Please provide title or role if "Other"

Phone

School

Please enter school if you selected Other

Department-MED

Department-GSDM

Department-SPH

Department-GMS

Please enter GMS Department if you selected Other.

School/Department--CRC

Please enter your school and department affiliation at CRC

Section-Department of Medicine

Section-Department of Obstetrics & Gynecology

Section-Department of Pediatrics

Section-Department of Radiology

Section-Department of Surgery

3) PI Information (if different from above)

PI Name

FirstLast

Degree

Faculty Rank (if applicable)

Email

Phone

School

Please enter school if you selected Other.

Department-MED

Department-GSDM

Department-SPH

Department GMS

Please enter GMS Department if you selected Other.

School/Department-CRC

Please enter school and department affiliation at CRC.

Section-Department of Medicine

Section-Department of Obstetrics and Gynecology

Section-Department of Pediatrics

Section-Department of Radiology

Section-Department of Surgery

4) PI eRA Commons Name

Does the PI have an eRA Commons name?*

PI's NIH eRA Commons name

The PI's NIH eRA Commons ID is necessary for the CRRO to obtain credit for the consultation to support the CTSI grant. The eRA Commons ID is given by NIH to principal investigators at institutions/organizations to access and share administrative information relating to research grants.

If the PI does not have an eRA Commons ID, he/she must obtain one to ensure proper credit for this consultation. If the PI is a BUMC or CRC investigator, please contact Kate Sokol, 617-353-4365 (ksokol@bu.edu); if the PI is a Boston Medical Center investigator, contact Ellen Jamieson, 617-414-5646 (ellen.jamieson@bmc.org). For more information, see http://ctsi.bu.edu/index.php/contact-us/

Which grants office do you typically use, or if you are a student or trainee, which does your mentor typically use?

5) Study Information

Study name/Project title (if applicable)

Study IRB Number (if applicable)

For funded projects, please indicate funder here.

Funder grant or project number

BUMC or BMC grant/account number

6) Student/Trainee Research

Is the study that will be the subject of this consultation considered student/trainee research? That is, the study is being conducted to provide research experience or to satisfy a program requirement for a student or trainee (includes residents and fellows).

If you answered No, skip to section 7.

Type of student/trainee

School

Please enter your school if you selected Other

Research is required by

If research is required by a training program, please describe

If research is required by a specific course, what is the course number?

7) If this is your first time contacting the CRRO, please let us know how you heard about the office.

CRRO Services Request

Clinical Research Resources Office