Research Intake Application Application Submitter Contact 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your last name, first name, phone number, and UA email address in the Application Submitter Contact Information section.
3. In the Study Information section, provide the Study UA IRB Number, Study Sponsor, Full Protocol Study Title, Sponsor Protocol Number, Current Protocol Version, and Current Protocol Date.
4. Indicate whether the study is open to accrual by selecting 'Yes' or 'No'. Fill in the total number of consented subjects and those currently on treatment or follow-up.
5. Answer questions regarding data collection from EU subjects and whether data will be deidentified as applicable.
6. Complete the Amendment section by selecting the type of amendment and providing any necessary amendment numbers or protocol versions.
7. If applicable, upload revised Consent Forms and Schedule of Events tables as prompted.
8. Fill out Contract/Budget Amendment Information with details about your Business Manager's contact information.
9. Provide PI information including current PI name and email. If changing PIs, complete additional fields for new PI details.
10. Finally, attach any required documents such as budget amendments or revised protocols before submitting your application.

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