ZIPLINE SUPPLEMENT: Participating Site in Multi-Site Research PURPOSE and INSTRUCTIONS This SUPPLEMENT should be completed only for a study that will be a participating site in multi-site research. It should not be completed when the sole involvement of the UW is to serve as a clinical, data, network, or overall study coordinating center for multi-site research. Use this supplement ONLY with applications submitted through the web-based Zipline application system. Upload the completed supplement to the Supporting Documents SmartForm. Complete this form. To answer a text box question, make sure your cursor is in the gray text field before typing or pasting content. Study Title: 1. QUESTIONS 1. Lead site. Describe the lead site for the overall study by answering the following questions. Name the institution that is serving as the lead site. 1.1 1.2 Name the overall principal investigator(s) for the study. 1.3 Name the principal investigator and institution that are receiving funding for the overall study from the sponsor or funding agency. 2. Number of sites. How many sites are participating in the overall study? 3. Management, coordination and support. Describe the overall study management, coordination and support by answering the following questions. 3.1 Name the institution(s) that are providing the following: None (place an in the box) Institutions “X” Overall study coordination Central laboratory, reading, or specimen analysis Clinical coordinating center Data coordinating center
ZIPLINE SUPPLEMENT: Participating Site in Multi-Site Research PURPOSE and INSTRUCTIONS This SUPPLEMENT should be completed only for a study that will be a participating site in multi-site research. It should not be completed when the sole involvement of the UW is to serve as a clinical, data, network, or overall study coordinating center for multi-site research. Use this supplement ONLY with applications submitted through the web-based Zipline application system. Upload the completed supplement to the Supporting Documents SmartForm. Complete this form. To answer a text box question, make sure your cursor is in the gray text field before typing or pasting content. Study Title: 1. QUESTIONS 1. Lead site. Describe the lead site for the overall study by answering the following questions. 1.1 Name the institution that is serving as the lead site. 1.2 Name the overall principal investigator(s) for the study. 1.3 Name the principal investigator and institution that are receiving funding for the overall study from the sponsor or funding agency. 2. Number of sites. How many sites are participating in the overall study? 3. Management, coordination and support. Describe the overall study management, coordination and support by answering the following questions. 3.1 Name the institution(s) that are providing the following: None (place an “X” in the box) Institutions Overall study coordination Central laboratory, reading, or specimen analysis Clinical coordinating center Data coordinating center
ZIPLINE-SUPPLEMENT-Participating-Site-in-Multi-Site-Research.docx