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Department of Surgery
Beth Israel Deaconess Medical Center
Facilitating Innovative Research and Surgical Trials (FIRST) Program
Services Request Form
First Name
Last Name
E-mail Address
Faculty Rank/Position
Professor
Associate Professor
Assistant Professor
Lecturer
Instructor
Research Associate
Research Administrator
Research Fellow
Postdoctoral Fellow
Resident
Biostatistician
Research Nurse
Research Assistant/Coordinator
Clinical Trials Specialist
Clinical Research Administrator
Medical Student
Graduate Student
Administrative Assistant
Other
Division
Acute Care Surgery, Trauma, and Surgical Critical Care
Plastic and Reconstructive Surgery
Bariatric and Minimally Invasive Surgery
Surgical Oncology
Cardiac Surgery
Surgical Sciences
Colon and Rectal Surgery
Thoracic Surgery and Interventional Pulmonology
General Surgery
Transplantation
Neurosurgery
Urology
Ophthalmology
Vascular and Endovascular Surgery
Otolaryngology
Other
Podiatry
Project Title
IRB Protocol Number
Are you the Faculty PI of the project?
Yes
No
Not Applicable
Who is the Faculty PI of the project?
First Name
Last Name
Is your request regarding a Clinical Scholarship Program (CSP) project?
Yes
No
Type of help requested. [Please check all that apply]
IRB navigation
Study design
IRB document submission
Database building
Regulatory guidance
Data collection/coding/validation
Human subjects protections training
Subject screening and recruitment
IRB audit readiness
Manuscript and grant writing
Research mentorship/guidance
Identifying funding opportunities
Research staff education/training
Sample processing & storage
Industry communications
Pre-submission grant application review
Biostatistics consultation
Lab Website Development
Scientific collaboration
Other
Protocol development
Grant document preparation
Survey development/validation
Briefly describe the reason for your request:
Please upload any documents related to this request. If you need to upload more than one document, please compress as a zip file before uploading.
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