INVESTIGATOR INITIATED STUDIES

CONCEPT PROPOSAL

1. GENERAL INFORMATION

Date

Study type

Please refer to PMI IIS guidelines to select the study type of interest

Sponsor/Investigator details

Please fill in the contact information below, and provide a copy of the CV

Full name:
Address:

Email:

Phone number:

Study facility

Please fill in the following information about the facility where the study is intended to be conducted
Name:
Address:

Website:

Study start date (target)

Total fund requested (if applicable)

Please indicate an estimate of the total fund requested in USD

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IIS CONCEPT PROPOSAL FORM

2. SCIENTIFIC INFORMATION

Study title Please indicate here the title of the study:

Background & Rationale

Please provide background on unanswered questions that the study is attempting to answer

Scientific aim(s) & Intended methodologies

Please describe the targets you want to achieve in answering the questions and which methodologies you intend to
use

Study Design

Please provide a concise overview of the study design, stating the type of experimental design

Study duration
Please indicate the main phases of the study and their estimated duration

3. REFERENCES

Please use this section to include any bibliographic references included in the concept

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