Carle Research Services Request Form

Thank you for your interest in conducting investigator initiated research at Carle. The Stephens Family Clinical Research Institute (SFCRI) administers Carle’s research resources and oversees its research activities. Please complete this form to help us better understand how we might assist you. The SFCRI will review your submission and provide feedback regarding the availability of resources and the operational feasibility of conducting research-related clinical activities. The review will include (but is not limited to) the following topics:

To what degree is there engagement and collaboration with a Carle clinician?
What is the availability of the target patient population and the sample size needed?
What will be the specific impact on patient care?
On what time frame can direct clinical impact be expected?
How will the study be funded and are the needed resources in place?
Can the project be implemented in the existing clinical space?
What is the scientific merit of the study?
If this is for a grant submission, when is it due? (We typically need 3 months.)

Note:

This is not a Carle IRB form nor a submission to Carle IRB. You may be directed here by Carle or the University of Illinois IRB offices to initiate a request for Carle research services.
Please mention in this form if you are requesting assistance to identify a Carle collaborator.
If this is a Carle resident or nursing project, please complete the appropriate form: Resident Project Intake Form or Nurse Project Intake Form.

First Name

Last Name

Title/Position:

Physician

Professor

Student

Other

reset

Please specify:

Workplace

Please specify your University of Illinois department affiliation

Please specify

Department

Preferred Phone Number

Does your request involve a new invention/method that has never been implemented or tried at Carle?

Yes

Unsure

reset

Who has ownership of this invention/method?

Expand

Please provide information about the types of services or assistance you would like to receive.

Expand

If you have a specific project in mind, please provide a description of the goals or objectives you hope to accomplish.

Expand

Is this a project in which a CIMED student could participate to assist you and gain research experience?

Yes

reset

If you have an outline, abstract, or research protocol for this project, please upload it here.

Upload file

If there is any other supporting documentation that you would like to provide, please upload it here.

Upload file

Please share any additional information about your request or project that you think would be beneficial for us to know at this stage.

Expand

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.