Request for CRRO Services

1) Please provide a brief description of your request*

Name of the person submitting this consultation request*

First Last

Will you be the main person working with the CRRO for the consultation?*

Yes
No

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

Main person's name*

First Last

Main person's role in this study*

Please provide main person's title or role if "Other"*

Main person's email address*

Main person's phone*

Main person's School*

Please enter main person's School if you selected Other*

Main person's Department-MED*

Main person's Department-GSDM*

Main person's Department-SPH*

Main person's Department-GMS*

Please enter main person's GMS Department if you selected Other.*

Main person's School/Department--CRC*

Please enter your school and department affiliation at CRC

Main person's Section-Department of Medicine*

Main person'sSection-Department of Obstetrics & Gynecology

Main person's Section-Department of Pediatrics*

Main person's Section-Department of Radiology*

Main person's Section-Department of Surgery*

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

Main person's degree(s)

Main person's faculty rank (if applicable)

3) PI Information

Is the PI the same as the main person working with the CRRO for the consultation (identified above)?*

Yes
No

PI Name*

First Last

PI Type*

PI's Degree

PI's Faculty Rank (if applicable)

PI's Email*

PI's Phone*

PI's School*

Please enter PI's School if you selected Other.*

PI's Department-MED*

PI's Department-GSDM*

PI's Department-SPH*

PI's Department GMS*

Please enter PI's GMS Department if you selected Other.*

PI's School/Department-CRC*

Please enter school and department affiliation at CRC.

PI's Section-Department of Medicine*

PI's Section-Department of Obstetrics and Gynecology*

PI's Section-Department of Pediatrics*

PI's Section-Department of Radiology*

PI's Section-Department of Surgery*

4) PI eRA Commons Name

Does the PI have an eRA Commons name? If not, please select "No." This form can still be submitted without it, but please follow the instructions to obtain and submit later.*

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 visit (http://www.bu.edu/rosa/sponsor-system-access/). If the PI is a Boston Medical Center investigator, please contact the BMC Grants Administration office through (grants.admin@bmc.org) with the following information:
--Full name
--Email address.
--eRA Commons Role (Postdoc, PI, Trainee, etc.)

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.

Is the student/trainee the same person as the PI identified in Section 3?*

Yes
No

Student/Trainee Name*

First Last

Faculty Advisor Name*

Type of student/trainee*

Trainee's School*

Please enter Trainee's school if you selected Other*

Research is required by*

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

If research is required by a training program, please describe*

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