Thank you for your interest in working with the ISP. Please compete the form below and we will respond within 3-5 business days. Thank you, Todd Brown, MD, PHD and The ICTR Navigators
Are you submitting this request on behalf of a principal investigator?
Yes
No
Does the Principal Investigator have a JHED ID?
Yes
No
What is the name of person submitting the request? First Name: Last Name: What is the JHED ID of the person submtting the request?
*if applicable**format should be jhedID@jh.edu*
Please select your primary school and department Please provide your phone number
First name of person submitting the request
Last name of the person submitting the request
Please select your primary school and department from the provided list
SOM: Administration SOM: Anesthesiology and Critical Care Medicine SOM: Art as Applied to Medicine SOM: Basic Biomedical Sciences SOM: Bioethics Institute SOM: Biological Chemistry SOM: Biomedical Engineering SOM: Biophysics and Biophysical Chemistry SOM: BSi NeuroTranslational Program SOM: Cardiology SOM: Cell Biology SOM: Cellular & Molecular Medicine Grad Program SOM: Comparative Medicine SOM: Dermatology SOM: DOM Infectious Disease SOM: Endocrinology SOM: Emergency Medicine SOM: Functional Anatomy and Evolution SOM: Genetics SOM: HealQ20:Q35th Sciences Informatics SOM: History of Medicine, Institute of the SOM: ICTR SOM: McKusick-Nathans Institute of Genetic Medicine SOM: Medicine SOM: Molecular and Comparative Pathobiology SOM: Molecular Biology and Genetics SOM: Nanomedicine SOM: Nephrology SOM: Neurology SOM: Neuroscience SOM: Neurosurgery SOM: Obstetrics and Gynecology SOM: Oncology SOM: Ophthalmology SOM: Orthopaedic Surgery SOM: Otolaryngology - Head and Neck Surgery SOM: Pathology SOM: Pediatrics SOM: Pharmacology and Molecular Sciences SOM: Physical Medicine and Rehabilitation SOM: Physiology SOM: Psychiatry and Behavioral Sciences SOM: Plastic Surgery SOM: Radiation Oncology and Molecular Radiation Science SOM: Radiology SOM: Sur Bay Gen Surgery BMC SOM: Surgery SOM: Urology Nursing: Acute and Chronic Care Nursing: Community-Public Health Nursing: Health Systems and Outcomes BSPH: Faculty Center and Academic Programs BSPH: Biochemistry and Molecular Biology BSPH: Biostatistics BSPH: Center on Adolescent Health BSPH: Environmental Health Sciences BSPH: Epidemiology BSPH: Faculty Center and Academic Programs BSPH: Health Policy and Management BSPH: Health Services Research Division BSPH: Health, Behavior and Society BSPH: International Health BSPH: Mental Health BSPH: Molecular Microbiology and Immunology BSPH: Population, Family and Reproductive Health WSE: Applied Mathematics and Statistics WSE: Bioengineering Innovation WSE: Biomedical Engineering WSE: Chemical and Biomolecular Engineering WSE: Civil Engineering WSE: Computer Science WSE: Electrical and Computer Engineering WSE: Geography and Environmental Engineering WSE: Institute for Computational Medicine WSE: Materials Science and Engineering WSE: Mechanical Engineering KKI: Audiology Department KKI: Behavioral Psychology Department KKI: Child Life/Therapeutic Recreation Department KKI: Family Center KKI: Functional MRI KKI: Muscle Center KKI: Neurology and Developmental Medicine KKI: Neuropsychology Department KKI: Nursing Department KKI: Nutrition Department KKI: Occupational Therapy Department KKI: Physical Therapy Department KKI: Psychiatry Department KKI: Social Work Department KKI: Special Education Department KKI: Speech and Language Department KKI: Training Center JH Community Physicians Applied Physics Laboratory KAS: Chemistry KAS: Physics and Astronomy KAS: Physics Other
Please provide your phone number
If you have selected other, please let us know your department and school
Name of Principal Investigator First Name: Last Name:
What is the JHED ID of the Principal Investigator*format should be jhedID@jh.edu* Please select the Principal Investigator's primary school and department Please provide the Principal Investigator's phone number
If you have selected other, please let us know the Principal Investigator's department and school
What is the first name of the Principal Investigator?
What is the last name of the Principal Investigator?
What is the JHED of the Principal Investigator?
Please select the Principal Investigator's school and department
SOM: Administration SOM: Anesthesiology and Critical Care Medicine SOM: Art as Applied to Medicine SOM: Basic Biomedical Sciences SOM: Bioethics Institute SOM: Biological Chemistry SOM: Biomedical Engineering SOM: Biophysics and Biophysical Chemistry SOM: BSi NeuroTranslational Program SOM: Cardiology SOM: Cell Biology SOM: Cellular & Molecular Medicine Grad Program SOM: Comparative Medicine SOM: Dermatology SOM: DOM Infectious Disease SOM: Endocrinology SOM: Emergency Medicine SOM: Functional Anatomy and Evolution SOM: Genetics SOM: HealQ20:Q35th Sciences Informatics SOM: History of Medicine, Institute of the SOM: ICTR SOM: McKusick-Nathans Institute of Genetic Medicine SOM: Medicine SOM: Molecular and Comparative Pathobiology SOM: Molecular Biology and Genetics SOM: Nanomedicine SOM: Nephrology SOM: Neurology SOM: Neuroscience SOM: Neurosurgery SOM: Obstetrics and Gynecology SOM: Oncology SOM: Ophthalmology SOM: Orthopaedic Surgery SOM: Otolaryngology - Head and Neck Surgery SOM: Pathology SOM: Pediatrics SOM: Pharmacology and Molecular Sciences SOM: Physical Medicine and Rehabilitation SOM: Physiology SOM: Psychiatry and Behavioral Sciences SOM: Plastic Surgery SOM: Radiation Oncology and Molecular Radiation Science SOM: Radiology SOM: Sur Bay Gen Surgery BMC SOM: Surgery SOM: Urology Nursing: Acute and Chronic Care Nursing: Community-Public Health Nursing: Health Systems and Outcomes BSPH: Faculty Center and Academic Programs BSPH: Biochemistry and Molecular Biology BSPH: Biostatistics BSPH: Center on Adolescent Health BSPH: Environmental Health Sciences BSPH: Epidemiology BSPH: Faculty Center and Academic Programs BSPH: Health Policy and Management BSPH: Health Services Research Division BSPH: Health, Behavior and Society BSPH: International Health BSPH: Mental Health BSPH: Molecular Microbiology and Immunology BSPH: Population, Family and Reproductive Health WSE: Applied Mathematics and Statistics WSE: Bioengineering Innovation WSE: Biomedical Engineering WSE: Chemical and Biomolecular Engineering WSE: Civil Engineering WSE: Computer Science WSE: Electrical and Computer Engineering WSE: Geography and Environmental Engineering WSE: Institute for Computational Medicine WSE: Materials Science and Engineering WSE: Mechanical Engineering KKI: Audiology Department KKI: Behavioral Psychology Department KKI: Child Life/Therapeutic Recreation Department KKI: Family Center KKI: Functional MRI KKI: Muscle Center KKI: Neurology and Developmental Medicine KKI: Neuropsychology Department KKI: Nursing Department KKI: Nutrition Department KKI: Occupational Therapy Department KKI: Physical Therapy Department KKI: Psychiatry Department KKI: Social Work Department KKI: Special Education Department KKI: Speech and Language Department KKI: Training Center JH Community Physicians Applied Physics Laboratory KAS: Chemistry KAS: Physics and Astronomy KAS: Physics Other
Please provide the Principal Investigator's phone number
What is the e-mail of the Principal Investigator? Who is the employer of the Principal Investigator? Please provide the Principal Investigator's Phone number
What is the Non-Hopkins PI E-mail?
Who is the employer of the non-hopkins PI
What is the non-hopkins PI phone number?
Which Special Patient Population are you interested in?
Which of the following are you interested in requesting from the ISP?
Please let us know of any other efforts you have made prior to reaching out to the ISP core for assistance
What is your protocol's title?
Please provide a BRIEF summary of your project
If you have selected other, please tell us briefly how the ISP core can help you
Please provide a brief summary of your key inclusion criteria (i.e. age, gender, diagnosis, medications etc.)
Please provide a brief summary of your key exclusion criteria (i.e. age, gender, diagnosis, medications etc.)
What is the target sample size?
Was this number determined with the assistance of a statistician?
Yes
No
Will this study be conducted at a single site or multiple sites?
single site
multiple sites
If multiple sites, are all locations affiliated with Johns Hopkins Medicine?
Yes
No
Which Hopkin(s) location(s) will you be working with?
If you have selected other, please let us know which sites you are working with
Which non-Hopkins sites will you be working with?
Is this request related to a grant submission?
Yes
No
If yes, what is the grant submission deadline?
* must provide value
Today M-D-Y
Which agency is this grant being submitted to?
Is this request associated with an IRB application?
Yes
No
Which of the following is the IRB of record:
JH School of Medicine
JH School of Public Health
Homewood
Other/Central IRB
Who is the IRB of Record for this study?
If you have selected other or central IRB, is there a Hopkins IRB for local context review?
Yes
No
Please provide your Hopkins IRB number
Is this a clinical trial?
Yes
No
Is this a sponsored clinical trial or an investigator initiated clinical trial?
Sponsored
Investigator Initiated
Is this an interventional trial involving a drug or device?
Yes
No
Please upload any relevant supporting documentation.
Examples include but are not limited to:
1. Grant Announcements
2. Protocol
3. Research Plan