Research Application Type
* must provide value
New Study - The study is not currently active at any MUSC site
Addition of RHN site(s) - Application is to add one or more sites to the currently approved IRB application
Currently Active Study - Study is active at one or more sites but additional sites are not being added at this time
Please enter the SPARCRequest (SPARC) number:
* must provide value
Contract Research Organization (CRO)
Have you uploaded your study's investigational brochure in SPARC?
* must provide value
Yes
No
There is no investigational brochure
Please provide the investigational brochure
Have you uploaded your study's protocol in SPARC?
* must provide value
Yes
No
There is no protocol available at this time
Please provide the protocol
Please enter the SPARCRequest (SPARC) number:
* must provide value
Please upload the lab manual (if available)
What is the current status of the study?
* must provide value
Pipeline (i.e. engaged in early discussion)
Feasibility questionnaire received from CRO/sponsor
Feasibility questionnaire from CRO/Sponsor completed
Pre-Site (PSV) requested
Start-up (i.e. Site selected and received budget/contract or regulatory documents)
What is the current status of the study?
* must provide value
Enrollment open
Enrollment closed
Please provide additional study status details:
Please select all services that are currently being utilized:
* must provide value
Please specify additional services being utilized:
Please upload your completed feasibility questionnaire
Has the Principal Investigator been identified for this study?
* must provide value
Yes
No
Where will the Principal Investigator be located?
* must provide value
Charleston
Florence
Lancaster
Marion
Chester
Kershaw
Columbia
Columbia Heart and Vascular Institute
Indian Land
Orangeburg
To be determined
Where is the Principal Investigator located?
* must provide value
Charleston
Florence
Lancaster
Marion
Chester
Kershaw
Columbia
Columbia Heart and Vascular Institute
Indian Land
Orangeburg
Principal Investigator First Name
Principal Investigator Last Name
Principal Investigator Email
Inpatient
Outpatient
Remote
Will any virtual methods be utilized?
* must provide value
If other, please specify:
For new studies: Please select all sites that will be included in the study.
For addition of RHN site(s): Please select only those sites that you are adding under this application.
* must provide value
How many patients would be potentially eligible for this study in Charleston?
How many participants do you expect to enroll in Charleston in a 12-month period?
Has a sub-investigator been identified for Charleston?
* must provide value
Yes
No
Sub-Investigator First Name
Sub-Investigator Last Name
Estimated start date for Charleston
M-D-Y
Please select all services that will be needed:
* must provide value
Please specify additional service(s) required:
Lab services requested
* must provide value
What is the current coordination support plan for the study in Charleston?Please choose all that apply
* must provide value
Will the Charleston coordinator be:
How many days per week will the coordinator be on-site?
How many patients would be potentially eligible for this study in Florence?
How many participants do you expect to enroll in Florence in a 12-month period?
Has a sub-investigator been identified for Florence?
* must provide value
Yes
No
Sub-investigator First Name
Sub-investigator Last Name
Estimated start date for Florence
M-D-Y
Please select all services that will be needed:
* must provide value
Please specify additional service(s) required:
Lab services requested
* must provide value
What is the current coordination support plan for the study in Florence?Please choose all that apply
* must provide value
Will the Florence coordinator be:
How many days per week will the coordinator be on-site?
How many patients would be potentially eligible for this study in Lancaster?
How many participants do you expect to enroll in Lancaster in a 12-month period?
Has a sub-investigator been identified for Lancaster?
* must provide value
Yes
No
Sub-investigator First Name
Sub-investigator Last Name
Estimated start date for Lancaster
M-D-Y
Please select all services that will be needed:
* must provide value
Please specify additional service(s) required:
Lab services requested
* must provide value
What is the current coordination support plan for the study in Lancaster?Please choose all that apply
* must provide value
Will the Lancaster coordinator be:
How many days per week will the coordinator be on-site?
How many patients would be potentially eligible for this study in Marion?
How many participants do you expect to enroll in Marion in a 12-month period?
Has a sub-investigator been identified for Marion?
* must provide value
Yes
No
Sub-investigator First Name
Sub-investigator Last Name
Estimated start date for Marion
M-D-Y
Please select all services that will be needed:
* must provide value
Please specify additional service(s) required:
Lab services requested
* must provide value
What is the current coordination support plan for the study in Marion?
Please choose all that apply
* must provide value
Will the Marion coordinator be:
How many days per week will the coordinator be on-site?
How many patients would be potentially eligible for this study in Chester?
How many participants do you expect to enroll in Chester in a 12-month period?
Has a sub-investigator been identified for Chester?
* must provide value
Yes
No
Sub-investigator First Name
Sub-investigator Last Name
Estimated start date for Chester
M-D-Y
Please select all services that will be needed:
* must provide value
Please specify additional service(s) required:
Lab services requested
* must provide value
What is the current coordination support plan for the study in Chester?
Please choose all that apply
* must provide value
Will the Chester coordinator be:
How many days per week will the coordinator be on-site?
How many patients would be potentially eligible for this study in Kershaw?
How many participants do you expect to enroll in Kershaw in a 12-month period?
Has a sub-investigator been identified for Kershaw?
* must provide value
Yes
No
Sub-investigator First Name
Sub-investigator Last Name
Estimated start date for Kershaw
M-D-Y
Please select all services that will be needed:
* must provide value
Please specify additional service(s) required:
Lab services requested
* must provide value
What is the current coordination support plan for the study in Kershaw?
Please choose all that apply
* must provide value
Will the Kershaw coordinator be:
How many days per week will the coordinator be on-site?
How many patients would be potentially eligible for this study in Columbia?
How many participants do you expect to enroll in Columbia in a 12-month period?
Has a sub-investigator been identified for Columbia?
* must provide value
Yes
No
Sub-investigator First Name
Sub-investigator Last Name
Estimated start date for Columbia
M-D-Y
Please select all services that will be needed:
* must provide value
Please specify additional service(s) required:
Lab services requested
* must provide value
What is the current coordination support plan for the study in Columbia?
Please choose all that apply
* must provide value
Will the Columbia coordinator be:
How many days per week will the coordinator be on-site?
Site #8 - Columbia Heart and Vascular Institute
How many patients would be potentially eligible for this study with the Columbia Heart and Vascular Institute?
How many participants do you expect to enroll with the Columbia Heart and Vascular Institute in a 12-month period?
Has a sub-investigator been identified for the Columbia Heart and Vascular Institute?
* must provide value
Yes
No
Sub-investigator First Name
Sub-investigator Last Name
Estimated start date at the Columbia Heart and Vascular Institute
M-D-Y
Please select all services that will be needed:
* must provide value
Please specify additional service(s) required:
Lab services requested
* must provide value
What is the current coordination support plan for the study with the Columbia Heart and Vascular Institute?
Please choose all that apply
* must provide value
Will the Columbia Heart and Vascular Institute coordinator be:
How many days per week will the coordinator be on-site?
How many patients would be potentially eligible for this study at Indian Land?
How many participants do you expect to enroll at Indian Land in a 12-month period?
Has a sub-investigator been identified at Indian Land?
* must provide value
Yes
No
Sub-investigator First Name
Sub-investigator Last Name
Estimated start date at Indian Land
M-D-Y
Please select all services that will be needed:
* must provide value
Please specify additional service(s) required:
Lab services requested
* must provide value
What is the current coordination support plan for the study at Indian Land?
Please choose all that apply
* must provide value
Will the Indian Land coordinator be:
How many days per week will the coordinator be on-site?
How many patients would be potentially eligible for this study at Orangeburg?
How many participants do you expect to enroll at Orangeburg in a 12-month period?
Has a sub-investigator been identified at Orangeburg?
* must provide value
Yes
No
Sub-investigator First Name
Sub-investigator Last Name
Estimated start date at Orangeburg
M-D-Y
Please select all services that will be needed:
* must provide value
Please specify additional service(s) required:
Lab services requested
* must provide value
What is the current coordination support plan for the study at Orangeburg?
Please choose all that apply
* must provide value
Will the Orangeburg coordinator be:
How many days per week will the coordinator be on-site?
Full Name of person completing this form
* must provide value
Email address
* must provide value
M-D-Y
Approved Declined
Yes
No
M-D-Y
Working...