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Clinical Research Recruitment Website This form is ONLY for posting on the Tuftsmedicalcenter.org website. Please review posting instructions/requirements on Page 2 IRB # Version Date Study Title: Short Title: Principal Investigator: Institutional Affiliation (select one): Tufts University (optional) Tufts Medical Center (required) Therapeutic Area(s): Choose from the list found at http://viceprovost.tufts.edu/HSCIRB/files/List-of-Conditions.xlsx: 1. 2. 3. 4. Contact Name for Respondents: Contact Telephone # for Respondents: Contact email for Respondents: Study Summary: Age Requirements: Minimum____ Gender Requirements: Male ______/Maximum _____ Female __________ Both Inclusion Criteria (list a maximum of 3 inclusion criteria): Exclusion Criteria (list a maximum of 3 exclusion criteria): Short Synopsis of Study Requirements: (e.g., number of research visits, length of participation, number of blood collections and volume of blood collected for research, number of x-rays/CT scans/MRIs): Clinicaltrials.gov Identifier: I have reviewed the information above and it is complete and accurate, and contains information limited to the fields above. ___________________________________________ Principal Investigator’s Signature Principal Investigator’s Name (typed or printed) Version 02/23/17 _________________________________ Date Clinical Research Recruitment Website Information Submission to the IRB is required for all studies to be undertaken at Tufts Medical Center. Posting to the site is optional for Tufts University projects. For studies reviewed by WIRB, approval is required for this form prior to posting. If additional descriptive information (such as payment, risks and potential benefits, or requesting identifiable information) is added, such information is considered part of the informed consent process and therefore requires IRB review and approval. Please submit an electronic copy of this form to Douglas Reichgott [email protected] (ext. 6-5609). MS Word version is preferred. The website is aimed at the general public. Do not use technical terms or jargon; information should be written at an 8th grade reading level for a non-medical audience. Investigational drug, biologic or device studies should not use terms such as "new treatment," "new medication" or "new drug." These phrases may lead potential subjects to believe they will receive newly improved products of proven worth. Therapeutic/Research Area(s) will be the field used for search criteria. Try to use disease states(s) to better assist potential subjects in finding relevant studies (for example, use “Lung Cancer” rather than “Oncology”) Consider referring to the study listing on www.clinicaltrials.gov for sample language. Version 02/23/17