Study Information (please add other personnel and their contact information as needed) Study Title: VCU IRB #: PI Name: Contact information: Study Coordinator: Contact information: Student Name (if Student project): Contact information: Biomedical Social Behavioral This research study is Both Biomedical & Social Behavioral Other: ___________ Biomedical Social Behavioral This research study is Both Biomedical & Social Behavioral Other: ___________ VCU IRB (A,B,C, or D?) _______ Western IRB [=]]]]]]IRB Used Central IRB Other: ___________ Industry Federal Foundation Funding Sources: Internal/Departmental (or not funded) Other: ____________ Sponsor Federal _____________ Foundation Internal/Departmental Monitoring Sources: CRC CRO _________________ Massey _______________ Foundation Other: _______________
Study Information (please add other personnel and their contact information as needed) Study Title: VCU IRB #: PI Name: Contact information: Study Coordinator: Contact information: Student Name (if Student project): Contact information: This research study is Biomedical Social Behavioral Both Biomedical & Social Behavioral Other: ___________ This research study is Biomedical Social Behavioral Both Biomedical & Social Behavioral Other: ___________ [=]]]]]]IRB Used VCU IRB (A,B,C, or D?) _______ Western IRB Central IRB Other: ___________ Funding Sources: Industry Federal Foundation Internal/Departmental (or not funded) Other: ____________ Monitoring Sources: Sponsor Federal _____________ Foundation Internal/Departmental CRC CRO _________________ Massey _______________ Foundation Other: _______________
BMR_PAM_SET.docx