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- 2024 Reporting Year

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About
Join GIQuIC
Current Participants
Research
Quality Reporting Programs/MIPS
- GIQuIC QCDR/MIPS
- 2024 Reporting Year

Research

Research Overview
GIQuIC Research Policies & Procedures
ACG/ASGE Epidemiologic Research Award
GIQuIC Research Publications
Research FAQ

RESEARCH REQUEST PRE-PROPOSAL FORM

RESEARCH REQUEST PRE-PROPOSAL FORM

"*" indicates required fields

REQUESTOR NAME:*

First Last

REQUESTOR EMAIL:*

REQUESTOR INSTITUTION OR ORGANIZATION:*

CO-INVESTIGATOR(S) NAME(S):

CO-INVESTIGATOR(S) INSTITUTION OR ORGANIZATION(S):

ARE YOU A MEMBER OF ACG?

Yes

No

ARE YOU A MEMBER OF ASGE?

Yes

No

TENTATIVE TITLE OF PROPOSAL:

FUNDING SOURCE:

ASGE

ACG

Other Society

NIH / Federal Grant

Industry Sponsor

Personal / Internal Funds

Other

Funding Source Not Yet Identified

PROJECT PURPOSE and SPECIFIC AIMS:

Pilot Data

Preparatory to Grant Submission

Journal Publication

Industry Use

Other

Other text

ARE THERE ANY DEADLINES FOR RECEIVING RESULTS FROM THIS REQUEST? IF SO, PLEASE DESCRIBE:

HYPOTHESES TO BE ADDRESSED:

Colonoscopy

EGD

DATA REQUESTED:

MM slash DD slash YYYY

STUDY DATE RANGE:

LIST MAIN VARIABLES OF INTEREST:

EXPECTED RESULTS:

PLAN FOR DISSEMINATION:

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