The College Diabetes Network: Research Assistance Request

First Name

Last Name

E-mail Address

University Affiliated with Research

Organization Affiliated with Research

Project/Study Type

If other, please explain.

Project Title

Source of project funding

If other, please explain.

Briefly describe the research project that you are working on.

Please list the objectives of your study and what you intend to use the findings for.

Please briefly describe how you picture CDN's involvement in this study.

If you are seeking recruitment for your project via CDN's outreach channels (social media, newsletters, etc.) please provide a 1-2 sentence description of your project for CDN to include.

What kind of research is this?

If other, please explain

How many participants are you looking to recruit? An approximate number is fine.

Do you plan on issuing incentives for CDN participants?

YesNoUndecidedNot applicable

Description of incentives

What type of participation are you expecting from individuals participating in the study?

If other, please explain.

Please list any other organizations involved in the study and how they are involved.

If there is a link relative to your research study (i.e online survey) please include it here.

When will this research study begin?

When will this research study end?

Status of IRB approval

Contact Information