FORM L-1
IRB #
HSC20--------FIND A STUDY RECRUITMENT WEBSITE
Note: If you opened this form with your web browser, do not complete it until you first save it to your computer. Then
close your web browser & open the form in Word
Study Contact Information
Prospective subjects can contact the study team for more information or to volunteer for recruitment.
Contact’s Name (Last Name, First Name):
Contact’s e-mail
address:
E-mail address
Last name, First name
Contact’s Phone
Number:
Phone number
Lay Title of Project: Create a study title that will be understood by a lay person. (255 characters max).
Note: If the lay title exceeds 65 characters, it will display as a truncated title on the Find a Study site.
Insert lay title here. 255 characters max.
Lay Description of Project. Create a brief description that will be understood by a lay person. (255 characters
max).
Insert purpose, objectives of the research project in lay terms here. 255 characters max.
Recruitment of Subjects
Recruiting – participants are currently being recruited through open recruitment
Enrolling by invitation only – participants are currently being (or will be) selected from a pre-determined
population (i.e., not open recruitment, may be enrolling from another study).
Is this study posted on another recruitment website already? (such as cancer.gov/clinicaltrials) If so, provide the
URL and unique ID number used on the website.
Insert Website URL here
Insert unique ID # here
1
FORM L-1
IRB #
HSC20---------
Study Categories - Indicate the study categories for recruitment purposes Check ALL that apply:
Healthy Subjects Needed
Lungs, Breathing and Bronchial
Diseases
Aging and Geriatric
Men's Health
Behaviors and Mental Disorders
Minority Studies
Cancers and Other Neoplasms
Mouth and Tooth Diseases
Children's Health
Muscle, Bone and Cartilage Diseases
Diabetes
Nervous System Diseases
Diagnostic
Nutrition
Digestive System Diseases
Reproductive Health
Ear, Nose and Throat Diseases
Rehabilitation
Eye Diseases
Skin Conditions
Emergency Medicine
Substance Related Disorders
Family Health
Urinary Tract and Kidney Diseases
Heart and Blood Diseases
Women's Health
Immune System Diseases
Wounds and Injuries
Other
2
FORM L-1
IRB #
HSC20---------
Cancer Site(s) - For oncology studies ONLY, list the targeted site(s) for recruitment purposes.
Brain and Nervous System
Multiple Myeloma
Breast (female)
Multiple sites
Buccal Cavity and Pharnyx
Myeloid Leukemia
Cervix, Other female genital
Non-Hodgkins Lymphoma
Colon
Other Hematopoietic
Kidney
Ovary
Kidney, Other Urinary
Pancreas
Lip, Oral Cavity and Pharynx
Prostate
Liver
Soft Tissue
Lung
Urinary Bladder
Melanoma (skin)
3