Download PeDRA Study Approval Form

Web: www.pedraresearch.org
PeDRA Study Approval Form: submit this form to apply for PeDRA study designation
Principal (Corresponding) Investigator:
Institution:
Site/Institution Address:
Corresponding PI E-Mail:
Phone Number:
**Studies must have a minimum of 3 PeDRA Members from 3 different institutions**
Collaborators (If co-PI, designate (Co-PI) after their
name:
__ 1.
__ 2.
__ 3.
__ 4.
__ 5.
__ 6.
__ 7.
__ 8.
__ 9.
__ 10.
Site e-mail
1. Disease specific group: Indicate the Disease Specific subgroup and/or Disease Specific Working group
in which this project has been discussed and vetted
__Birthmarks and Procedural
__Inflammatory: Psoriasis
__Inflammatory: Atopic Dermatitis
__Inflammatory: Connective Tissue
__Inflammatory: Hair/Nail/Special Sites
__Inflammatory: Acne
__Genetic Skin Disorders: Disorders of cornification
__Genetic Skin Disorders: Epidermolysis bullosa
__Genetic Skin Disorders: Other
__Neonatal Skin
__ Skin Tumors And Reactions to Cancer therapies/STARC
__Additional Research Area - Description:________________________________________________________
Study Title:
Description of study:
Research Question and What this Study Would Add:
Study Design and Methods (including number of sites, sample size…):
Have you met with a statistician (circle one)? Y
N
If no, do you plan to include a statistician in your study?
Anticipated Expenses (e.g., database, research assistant support, materials):
Anticipated Funding Sources (e.g. SPD, DF, Industry, Unfunded):
IRB Status: ___Approved ___Submitted ___In preparation ___Designated as exempt
Anticipated timeline (e.g., enroll first patient, completion of data collection, etc.):
2
References: max 3
3