CVRN Proposal Submission Form

Do you have a CVRN Proposal? Please complete the form below.

ADMINISTRATIVE

First  
Last Name  
Degrees(s)  
Job Title  
Email Address  
Phone Number  
Institution  
Department  
City  
State  

Reason for Inquiring (mark all that apply):

Learn more about CVRN data and research capacity
Collaborate on a potential grant proposal
Connect with CVRN investigators to implement a funded project
Other:

Funding Source:

Grant support has already been awarded by (list agency):
A grant proposal is currently under review by (list agency):
We plan to submit a grant proposal in the next 9 months
Just exploring at this time
1. Project Title:
2. Lead Investigator Name(first, last) and primary Institution(if different from submitter):
3. Proposed co-investigators (Names, Affiliation), if any
1.
2.
3.
4.
4. Brief description (Not required)
Background:
Aims:
Study Design:
Target Population:
Predictor Variables:
Analytic Approach:
5. Keywords
6. Is this proposal requesting distribution of a dataset outside of a CVRN site?
Yes No


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