Please complete the following ORS Clinical Trials Form. The items marked with asterisk (*) are required.


General Form Info

*Please select the request type

Submitter

*First Name *Last Name
* E-mail

Principal Investigator

*PI First Name *PI Last Name
*PI Department

Study Identifier

*GCO HSM

Project Info

*Title of Project
*Brief Lay Term Summary (4000 char max)
*Currently Enrolling?
*Health Topic 1 Health Topic 2 (if needed)

Project Contact Info

*Contact First Name *Contact Last Name
* Contact Phone Number
* Contact E-mail
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