Download Project Title: - Office of the Vice Provost

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