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711 Concession Street, Hamilton, Ontario
tracetrials@mcmaster.ca
TRACE Intake Form
Principal Investigator/Key Contact
PI Name
Institution
Email Here
Co-Investigators
Study Design
Study Title
Study Title
Study Phase/Design
Study Objective
Patient Population
Estimated Sample Size
Randomization:
Yes
No
Study Intervention/Control
Treatment Schedule
Is Regulatory Approval Required?
Yes
No
Unsure
Correlative Studies:
Yes
No
Unsure
Feasibilty & Timelines
Estimated Number of Clinical Sites
Planned Countries
Estimated Accrual per Month
Clinical Trial Duration (yrs)
Recruitment Duration
Follow-up Duration from Baseline
Anticipated Start Date
Study Rational & Objectives
Study Rational
Funding Status
Grant Awarded:
Yes
No
Granting Agency
Grant Application Pending:
Yes
No
Pending Application Agency
Submission Deadline
Industry Funding/Support:
Yes
No
Industry Partner
Estimated Trial Cost
List Any Other Sources of Support
Additional Comments
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