Clinical Investigation

Service Request

Your Contact Information

(Person submitting the request)

Principal Investigator Information

Investigator Type

Investigator Rank

Gender

 

NIAID further requires that we collect demographic data on the investigators we serve. This also allows us to better respond to future opportunities. Please select one option below:

Racial Category

NIAID further requires that we collect demographic data on the investigators we serve. This also allows us to better respond to future opportunities. Please select one option below:

Administrator Information

(Person to contact regarding payment for services)

Purpose of Request

Funding Information

NIH-sponsored study

Select the appropriate information from the drop down menus if available.

If you do not see your grant number or title, you may enter them into the fields below labeled, "Other Grant Number" and "Other Grant Title"

Institution Administering the study

Program

Non-NIH Sponsored Study

If your study is not NIH sponsored, please enter study title below.

Clinical Investigation

      

Study or Grant Title

 

Please enter the name of your study. If the name is the same as the grant title, please enter into this field. 

Study Description

 

Please provide a brief description of your study. Include information you weren't able to include above about your grant and potential funding (i.e., anticipated sources of funding, funding status, and whether or not the study is supported by a CFAR grant) 

Services Requested

 

More than one service can be selected.

Please hold down 'ctrl' to select multiple services.

 

Are the samples or data derived from human subjects? 
By selecting "Yes", you are confirming that you have the appropriate approvals in place (i.e., IRB approval).

 

File to upload (only PDF files are accepted)

 

Service Request Status

 

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I agree to acknowledge the CFAR grant on all publications, abstracts, grant proposals and presentations resulting from work supported by these services. Please refer to Cite the CFAR for details.