Bronchiectasis and NTM Association: Project Proposal Review Form

Bronchiectasis and NTM Association: Project Proposal Review Form
Name*

First NameLast Name
Institution*
Email*
example@example.com
Project Information
Proposed Project Name*
PublicationPreliminary research/information gatheringPatient recruitment (e.g., clinical trials or research studies)Other, please specify
Please provide further information on what data you are looking to access and what it is for (a grant, feasibility, raw data, etc.):
AbstractManuscriptOther, please specify
Abstract: Specify Conference*
Publication: Background*
Publication: Hypothesis*
Publication: Specific Aims*
Patient Recruitment: Specify Enrollment Goal*
Patient Recruitment: Specify Inclusion/Exclusion Criteria*
Sponsor and Timeline
YesNo
If yes, please specify.*
Please indicate the timeline for this request:*
Provide the rationale for your timeframe.*
Please note, requests for use of the full Registry dataset must be analyzed by an Association biostatistician. For participating BRR and CCN sites, site level data may be analyzed by the site.
To complete and submit form you must click "review" button below. Once answers are reviewed, please click "submit" at the bottom of the form to complete.
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Project Information