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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 sizeā¦): 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