PeDRA Study Application

Instructions

Complete the following application for your study to be considered as a PeDRA Study. PeDRA Studies receive many benefits, including centralized biostatistician or project support, eligibility to apply for Study Support Grants, and being featured on the PeDRA website. The extent of benefits provided may vary according to the nature and scope of each study.

Applications will be reviewed on a rolling basis and outcomes shared within approximately 8 weeks.

Eligibility

1. Study must be overseen by an Active Member of PeDRA (the principal investigator) working in collaboration with at least one other investigator. Other investigator(s) need not be active PeDRA members.

2. Study must be relevant to the field of pediatric dermatology.

3. Investigators may reside at either the same institution or at different institutions. However, at least one investigator must reside at an institution within the United States, Canada, or Mexico.

4. The same individual may submit an application on behalf of multiple studies, but only one application is allowed per study.

5. Principal investigator must agree to ongoing communication and project updates with PeDRA via periodic phone calls and/or email.

6. Principal investigator must agree to acknowledge PeDRA on all publications and presentations resulting from the study.

Principal (Corresponding) Investigator

First Name

Last Name

Degree(s)

Email

Primary Affiliation

Is the Principal Investigator an Active Member of PeDRA?

YesNo

Study Information

Title

Subject Area (select all that apply)

Acne & HSAtopic Dermatitis & PsoriasisBirthmarksConnective Tissue & Autoinflammatory Drugs & BugsEducationGenetic Skin DisordersHair DisordersNeonatal SkinSkin of Color & Pigmentary DisordersSkin Tumors and Reactions to Cancer TherapiesOther/Not sure

Study Status

New study Ongoing studyOther / Not sure

Is your study already considered a PeDRA Study?

YesNoNot sure

Please provide any additional information on the study status here:

Study Hypothesis (50 word max)

Study Overview (250 word max)

Estimated Budget (USD) - please indicate if you aren't sure

Estimated study duration (in months) - please indicate if you aren't sure

Anticipated funding sources

Co-Investigators

Please list all co-investigators working with you on the study. It's okay to provide only first and last name of each co-investigator. PeDRA may contact you for additional details later.

Co-Investigator 1

First

Last

Degree(s)

Affiliation

Check here to add another investigator

Co-Investigator 2

First

Last

Degree(s)

Affiliation

Check here to add another investigator

Co-Investigator 3

First

Last

Degree(s)

Affiliation

Check here to add another investigator

Co-Investigator 4

First

Last

Degree(s)

Affiliation

Check here to add another investigator

Co-Investigator 5

First

Last

Degree(s)

Affiliation

Check here to add another investigator

Co-Investigator 6

First

Last

Degree(s)

Affiliation

Check here to add another investigator

Co-Investigator 7

First

Last

Degree(s)

Affiliation

Check here to add another investigator

Co-Investigator 8

First

Last

Degree(s)

Affiliation

Check here to add another investigator

Co-Investigator 9

First

Last

Degree(s)

Affiliation

Check here to add another investigator

Co-Investigator 10

First

Last

Degree(s)

Affiliation

Check here to add another investigator

Co-Investigator 11

First

Last

Degree(s)

Affiliation

Check here to add another investigator

Co-Investigator 12

First

Last

Degree(s)

Affiliation

To include more than twelve co-investigators, please send the list of additional investigators by email to info@pedraresearch.org referencing your study title and primary investigator name.

PeDRA Support

Please indicate which PeDRA support services you are, or may be, interested in (select all that apply)

Connections with collaborators	Centralized biostatistician support
Central project coordination	Site recruitment
Patient recruitment	Statistics funding and/or support
Publication funding and/or support	Start-up support
Regulatory support	Communication/dissemination
Other

Please indicate other support services you are interested in:

Contact Information