PenCTU support request form

Please complete the form below in order to register a formal request for PenCTU support. Our ability to provide support depends on a number of factors including scientific rigour of the application, proposed funding source, CTU capacity and local strategic priorities. As we are likely to be supporting several research proposals at any one time, we ask that support requests are made at least three months prior to any funding application deadline. Please appreciate that requests made outside this timeframe are less likely to be considered for CTU support.

A member of PenCTU will contact you on receipt of a support request form in order to discuss next steps.

Applicant details

Name of lead applicant *

Current post

Institution

Is University Hospitals Plymouth NHS Trust (UHP) a partner in your research? * *

Yes

No

Telephone *

Email *

Names of co-applicants

Project details

Research question/Project title *

Anticipated start date *

Total duration of study *

Number of participants

Number of centres

Intervention(s) (if relevant): *

Control/comparison (if relevant):

Is it a CTIMP? *

Yes

No

Don't know

Outcome measures

Time points of data collection *

What assistance or support would you like the PenCTU to provide? (please tick all that apply) *

Have you had any input from any other source? (please tick all that apply) *

NIHR Research Design Service (RDS)

Other CTU**

Other**

Please specify your source**

Has an organisation provisionally agreed to act as study sponsor?*** *

Yes

No

If yes, please enter the name of the sponsor organisation.

***The sponsor is the individual, organisation or partnership that takes on overall responsibility for proportionate, effective arrangements being in place to set up, run and report a research project. All health and social care research has a sponsor. The sponsor is normally expected to be the employer of the chief investigator in the case of non-commercial research or the funder in the case of commercial research. The sponsor has overall responsibility for the research.

Are you applying for funding? *

Yes

No

If yes, what is the deadline for application?

What is the target funding body?

Once you have submitted the support request form can you please send the latest draft of your application/protocol to penctu@plymouth.ac.uk.