YCCI
Ad Request Form
1. Clinical Trial Name: Click here to enter text.
2. Brief Description of Trial: Click here to enter text.
3. HIC Number: Click here to enter text.
4. Type and Number of Participants Needed: Click here to enter text.
5. Budget: Click here to enter text.
6. Due Date: Click here to enter text.
7. Media Guidelines:
i. Do you need a recommendation as to where the
advertising should appear? Yes ☐ , No ☐
ii. If Yes, what has worked in the past? Click here to enter
text.
b. If No, where do you want the ads to appear?
i.
New Haven Register
ii.
New Haven Advocate
iii.
Other News Papers… specify Click here to enter text.
iv.
Radio… specify Click here to enter text.
v.
TV… specify Click here to enter text.
vi.
Online… specify Click here to enter text.
vii.
Other… specify Click here to enter text.
c. Print Specs (size, 4C, BW etc.): Click here to enter text.
d. Ad frequency – how many times per week or month
should the communications run? Click here to enter text.
8. Messaging Guidelines:
a. Main Message (What is the single most important point to
communicate?): Click here to enter text.
b. Supporting Messages (Reinforcement of main message
and additional points): Click here to enter text.
c. What compensation is being offered to participants? Click
here to enter text.
d. Call to Action (How is prospect to respond?): Click here to
enter text.
e. If you have suggestions for photos or other images that
should be used please specify: Click here to enter text.
f. What disclosure copy has to be included in the
messaging? Click here to enter text.
9. Person completing this advertising request:
Name: Click here to enter text.
Phone: Click here to enter text.
Email: Click here to enter text.
To request ad redesign services, please contact:
Kelly Anastasio
Associate Director, Clinical Trial Resources
Telephone: 203.737.6845
Email: clinicalresearchresources@yale.edu